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APPLICATION F(,,-,SANITATION PERMIT Permit No. dKII,q/1 Date Issued 6 (Complete in Duplicate) y ' IV-t_ .: Application is-hereby made to the San Joaquin Local Health District for 'a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCANi--------- Z�-------------------_- -------------I--------------------------------------------------- Owner's Name----- k_ 45, Phon-4- ------------- -Addr - --- ----------- �_-- ess�..... -- ---- :- ---- -- ----------- ---------------------------------------- - Z-------------------- Contractor's Name-- .... ------ -- ---- ----I--------------------------------------------------------------- Phone/-- --------------- Installation will serve: Residence Apartment House El Commercial E] Trailer Court ❑ Motel E] Other ❑ Number of living units: _/---- Number of bedrooms ---- Number of baths Lot size -------------------------- Water Supply: Public sys+emNZ" Community system 'E] Private F] Depth to Water Tablez/.�ff. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam 0 Clay Loam E] Clay E] AdobHardpan 171 t 9-kr Previous Application.Made; Yes [-] No&� New Construction: Yes No E] FHA/VA: Yes [I N9_V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ar'cess000l permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well,.--A--17 Distance from founclation---/47__"_r__.Maf_eriaI----- ----------------------------- No. of cbmparfmenfs______ ----------------Size_____.. depth___! �'Capacity-------F I IP_ ' 1_? Disposal Field: Distance from nearest well_________________Distance from f8undafion--------------------Distance to nearest lot line_______________-_ ❑ ine----------------- ElNumber of lines-------------------------------- Length of each line--------------------_---------Width of trench.--------:-------------------__-.-- 1 rench.---------I-------------------------- Type of filter material------------------ Depth of filter material-----------------------Total length---------------------------------------- 1 ength------------------------------------------ Distance to nearest well ----Distanc 'from dafion-- _Distance to nearest lot line------;�__ Seepage Pit- 0 L�ning maferia e 21------------ ---- ---------------- _--Size: Dia Vr Number ' i pits----- meter_--.?e`,----Depth-------- --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-_--.______-_______________________ \ ❑ aterial.------------------------------------- 0 Size: Diameter------------------------- ------------Depth--------- --------- -----------------------------Liquid Capacity----------------------------gals.�; Privy: Distance from nearest well-----i-------------------------------------------Distance from nearest building_________.___________________-__.__-. ❑ Distance uilding------------------------------------------ Distance to nearest lot line.---------------------- -------------- --------- ---------- Rem dekng and/or repairinge" --- --- - --------------- ------------- ----------------------------------------------------•-/_---------_--•-----_•-----_ J_- -------------------------•------------------------------I--------------------- -------------------------------------------------------------- -------------------------- - "--------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- . I hereby certify that I have prepared this application and that the work will be done in accordance-with San Joaquin County ordinances,KstT tte llaws;:ea rd rules and regulafl-66in- of the San Joaquin Local Health District. Z------- ------------------------------------------------------------------------ --------------------(Owner and/or Contractor) (Signed)--- ------------ ........ By:----------------- .... ---------------------------------------------------------------------------- - - ------------------------ (Plot plan, showing.size of 16t, location of system in to wells,.buildings, etc., can be pIaqed.on re erse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ ----------------- ------- --------------------------------------- DATE------------------------------ ------------ j REVIEWEDBY--------------------------------------------- ------------------------------ -- ----------------------------------- DATE----------------- -• -•---------------------------BUILDING PERMIT ISSUED----------------------------------------------- ---------- ------------ DATE----7------ ------------------------ Alterations and/or recommendations:---------------------- ;c ir ------------ ----- ---------------------------------------------------------------- --------------------------------------------------------I-------------------------------------- ----------------------------------------- -------------------------------------------- ------------------------- -- ------------ ------------ ....... --------------------- -------------------------------------------fa _;;AU---------- ------ -----------------------------------------------:---------- _;0F----------- --- -------------- -- ------------------------------ -----------------------------------------=--.---------------- --------- -----------------------------t----------------------------------------------------- -------------------------------- )N -BY-..A ----- -------------------- Date--- -------------------- FINAL INSPECTION ------ ----------- -------------•------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisna 1.57 FPLCO'