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n APPLICATION FOR SANITATION PERMIT . Permit No. 1 r� . (Complete in Duplicate) LL "OmY Data Issued pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. its application is made in compliance with County Ordinance No. 549. - (AJJOB ADDRESS AND LOCATI ----------- `_`` ------------------------------------------------------------....-_-•------------------------------- ..__..jj_ ,,��--** ' dSa – ------------------------- ------- ------------------------------------ Phone-90.6 Owner's Name----�._�L�1:�L� K _ �-•--- Address.. 1 --------------•---------------------------------=---------------------------------- -•------------------------------------------------._ .. Contractor's Name-..-,- ame__ •------------------------------------------ ----------------------------------------------------- Phone- ° '. /��o Installation willserve"Re'side'nce House ❑ Commercial [❑ Trailer Court ❑ Mot) ❑ Other ❑ t f g Number of bedrooms --'2—. Number of baths ---1--- Lot size ._____!____ _ _______ __ __ ________________-__-_ Number of living units: __1____� Water Supply. Public system.[9"�`Community system ❑ Private"❑—Depth'to'Wafer Table _: ___-_ ft. f Character of soil to a depthof 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E`-Hardpan ❑ Previous ApplicaTioniMade: Yes ❑ No Construction: Yes [Ej'No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS— [No sseptic�tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- . Distance from rearesf well-----------------Distance from foundation___________________ Material----.------_------------------_----------.___-._. No. of compartments--=--------- ---- -----.Size---------------------------------Liquid depth------------------------Capacity------ --------------- DisposalField: Distance from nearest well----___-------__!Distance from foundation--------------------Distance to nearest lot line______.____----. Number of lines------------------------- ._'Length of each line___________-________..____._.Width of trench-._.--___._.-------______._____-__- -L V Type of.filter material---_ r -'-- ----iDepth of filter material-----------------------Total lengfh_---------=-----.----_--------------._---. J. Seew an _Distce from foundation___J_Q------------Dis Oce to nearest lot iine ps at: Distance to nearest well__s__. � -�_ Number of pits.____-t_._..__._'__t.Lin'sng material----1A( --------Size: Diameter___L_ ---------- �„ ❑ I __ � Distane from foundation_-___-___________..Lining material -------------------- ____________Distance from ( }ess vol: nearest veI ___." Size: Diameter-'---------'-Z---- ' .. ----•---- ------------- d Capacity----------------------------gals . Privy: Distance from nearest well---'-;-."'_____._..__--__________________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lotrline = ------ - ------------- •---------------------- ------------------------------- D Remode ing and/or repairing {desr' e)Cvkd ;, °�. ----- ------ �� ---------=---- - I -`--------------•--a� ----`'�- �-�--------------- ---------------- I ----------------------•----------------------•-------------------•-------------------••--------------------•-----------------------------------•------------- --------------------------------------------------------------- --------------------------------------•----------------= -•----------------•-•-----------•------------------•----------------------•---------------------•----------------_--------------------- •---------------- I hereby certify that I havejptepared this application and +hat the-work will-be done in accordance with San�Joaquin County ordinances, State laws, and rulers alnd regulafions of the San Joaquin Local Health District. (Signed)..-- ---------- ------• --------------•------------------�=------------------ -- --------------------=---^.:-- ----------------------- ----- -(Owner and/or Contractor) BY� "v Xx "'-� [Title -�� - ----------------------- (Plot plan, showing size lot, location of system.in relation to wells, buildings, etc., can be placed on reverse de). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ ----------------------------------- -------------------=--------------------------- DATE= -------- REVIEWEDBY F ---------------------------------------------------- DATE--._----!--------------------------------------------- BUILDINGPERMIT ISSUED------------------------------- . -----------------._ DATE____- _- -------------------------------------------- : . Alterations and/or recommendations:.-- ------- ---- -------`1---------------------------------------••---------------------.--------------------------- ------------------------------------------ --------- ---- - • - 1_A-J--1-r---( .fi_G.il. c.&.__to_..- _Zr ..,af------4------ 4•L_r' --- �� ?: 5 r s4 - -------------I-------------------------------------- ------------ ---------- ----------------------------------------- f a ` Date.FINA' INSPECTION BY: - ` � '� � 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 µ ES---9-2M 0-52 Revised W-2100