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Ute' :i y/ C APPLICATION FOR SANITATION PERMIT Permit No. 5 - (Complete in Duplicate) g Date' Issued ---- v_ /�cons-�Application is hereby made to the San Joaquin Local Health District for a permit to u and install thew k`-herein escribed. This application is made in compliance w" h County�Ordinance N 549 �i JOB ADDRESS AN OCATION------- -----�--- - ------ --------- -I-- --------------------- - --------------------•------------------------- ---------------'-------------------- Owner's Name - ------------• --6---------- ----• Phone------------------------------- Address--14 62------ ------- - ------------- ------------------------- --- --�`---- ---------- -- --------------------------- P--onEIA�` Contractor's Name--•------__---. ! ---- - -- hone __ __ --`f-------------- -- Installation will serve: Residence ❑ Apartment House ❑ Commercial [❑ -frailer Court El Motel ❑ Other Number of living units: __/_ Number of bedrooms _/. Number of baths _/-_ Lot size __!_ 1 .11-' ---------------------- Water Supply: Public system ❑ Community system ❑ Private 2""Septh to Water Tablea7o it. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'❑ Hardpan ❑ Previous Application Made: Yes ❑ No CT"New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well_________Distance from fq undation -------Mate�il__r_!_ '--_- ___.____ No. of compartments______-__-_-_�__tsize__S1a-XfP.___Liquid dep�h--__-_ __��yZ_.____Capacity__1J_ Disposal Field: Distance from nearest-well-s?�_____._.Distance from foundatign__.,, Q--------Distance to nearest lot line_------3__-. Number of lines-------- Length of each line___&D_____________ Width of french___r Type of filter material___ _ ' Yp 1�-- - ----Depth of filter matenai____��`---_- ---Total leng#h___-_.�---------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------..----..Distance to nearest lot line----------------- El Number of pits----------------------Lining material--_--------------------Size: Diameter-----------------------Depth---------------------------__ -- Cesspool: Distance from nearest well-----------------Distance from foundation_~+--------------- Lining material-----_____________._____------______- 1 ❑ Size: Diameter------------------------ -------------Depth------------------------------ -------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building____________-_-_-______ ❑ Distance to nearest lot line- ----------------------------------------------- Remodeling and/or repairing (des crib ---- --------------- ----------------------------------------- ---------•-----------------•----------•------------------- -----------••--------------------------------------------------------------------------------------------•--------------------------------- -----------------------------------------•--------------------------=-•--•------.----------- ----------------------------------------------------------•--=-•----------------------------------------------------- - -- ------------------------------------ ------------------------------------------------------------------•-----------------------------------------------------------------------------------•------------------------------- -- I hereb ertify f have repared this application and that +he work will be done in accordance with San Joaquin County ordinances, fa a laws nd les and re ulatior f the San Joaquin Local Health District. , (Signed) d�L--��- -- ---- ------ --------- ------------------------------------(Owner and/or Contractor r By:-------------------------------------------------------- c�P— � - --------------- ----------------------------- ---------------------------- _(Title)_ (Plot plan, showing size of lot, location of system in relation to ell , b idings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------- ----- ---------- --------------------------------------- DATE---- -- -------------------------------------- REVIEWED BY ------------- DATE ? BUILDING PERMIT ISSUED-------------------------- ----------------------------------------------- ------ DATE---- Alterationsand/or recommendations--------- --------------------------------------------•------------------------------------------------•---•---------------------------------------------------- ---------------------------•----------------------------------•------- 3 -----------------------------------------------------------• -----------------------------------•-------------------------------------------------------------------------------------=----------------------------------- •--------------•------------------------ --------- -•---•--- - - ------------------------------------------------------------------ 1 ------------------ FINAL INSPECTION BY:----- ----------------------------------- Date----- r' sl SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Man+eca, California Tracy, California ES-4-2M Revisea 1.57 F.P.co. 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