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T �S� APPLICATION FOR SANITATION PERMIT Permit No. ._,CI _3- .__ '} (Complete in Duplicate) Date issued ___XV6 Application i; 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 wifh�CJounty rdinan}ce�No. 549. JOB ADDRESS AND LOCATE N �} I 5".��'i-c4, ------------------------ ---------------------------------- Owner's Name--------L+--ii-i---- '�1� . Phone ��_._ 1 Address-------------------6_q.--�--------- :- ----�� &Nb ---- f--------------•--- ' ---d�----------•-- -- - -- 'Phone Contractor's Name =f�fl�WU✓Y1C F �J ------------------ Phone------------------•---------------- Installation w"l serve: Residence [V Apartment House F] Commercial ❑ Trailer Court [:] Motpl E] Other ❑ Number of living units: ---tI---- Number of bedrooms _3-- Number of baths ___t___ Lot size --- . _ ( - Water Supply Public system VCommunity system ❑ Private ❑ Depth to Water Table 0 ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [d New Construction: Yes ❑ No F FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted ifTublic sewer is available within 200 feet.)I ?ti ;u�$- Septi Tank: Distance from nearest well-_-_-_ -__ __Distancq from foendation---�__��_----------Material---------�}�� ----------. Size_OX•7X01---------Liquid depth----44--- - --------Capacity No. of compartments:____ - - Dispo al Field: Qistance from nearest well_- _ _ �. -__Distance from foundation---- Q____ Distance to nearest Number of lines------------i---------------------Length of each line_--- __•t-------------Width of trench.-.-- --- ----------------- Type of filter material______-_________________Depth of filter material____-___-__-_-____:.Total length-_---__-.-_-____________________-_-______. Seepage Pit: Distance to nearest well----------------------Distance from foundation___._____-_____.-..Distance to nearest lot line__.____________- Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------_---------------- Cesspool: . Distance from nearest well-----------------Distance from foundation.-..________---___.Lining material_-.---------------------------------_ ❑ Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------- ---- ----------------------Distance from nearest building-_______________-__-_-_-____--------____-. ❑ Distance to nearest lot line----------------------------------------------- -------------------------------------------------------------------------------------------- ` Cl -- -- -------- -- -:CL --- -- -- R m el ng and/or r airing (detribe): _ �------ � AA - +--•--•-----------------------•- ----------•----------------------------! ... I----- ----------------- ---------------- ----------------------------------------------•----------•------------------------------• ----------------------------------------- --- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and es ap4 re ulations of the San Joaquin Locai Health District. (Signed)-- ------- `-------- --- - ------ ---------- ----------------------------------------------------------------------(Owner and/or Contractor) $ (Title)_ • ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -- --- -----P------------- -------- ------------------------- DATE--_- ---- - REVIEWEDBY-------------------------------- ------------ - ------------ ------------------------- DATE---- ='-I- __ -- ----------- -------------- BUILDING PERMIT ISSUED------------------------------ ---------------- - DATE Alterationsand/or recommendations:--------=-------------------------------------------------- -------------------------------------•------------------------------•---------------•-------------- -------------------------------------------------------------------•------------------ ------- -------------------•-------------- ----- --------------------------- ------------- ------ ---------------------------•------------------------- - ---------------- -- -- ---- -- ------- ------------------------------------------------------------------------------------------------•-------------- FINAL INSPECT' N BY:. _ ---------- Date----------�-.3Q SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.0O3