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APPLICATION�FOR SANITATION PERMIT . Permit t No. �(Cornplete in Duplicate) �1( Date Issued _---k. .- Application ris.hereby made to the San Joaquin Local Health District for aermit to construct p o struct and install the work herein described. This application is:made ;n compliance with County Ordinance No. 549. ,, .,� 9 JOB ADDRESS AND�LOPA .1 / F---�----'� , F ----------------------------- •-,_ _,�__�.•----/�--�1 - .. = - --------------------------------------- --------- - " --sy•---t-�--- ------------. -- --- F ----------------Owner's Name------- ------ A/6- ?l ---- . , Phone Address-------------------- ------------------------- Contractor's - /.. Name ----•------------ -------sr• �. f -- --- ---•- = 11 P one-}--•---•------------•--•-------... Installation will serve: Residence Apartment 'House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other ❑ Number of livingunits:--__.-- Numberof b;- _ edraoms£ __-_ Number of bath' lY Lot size - �... Water Supply Public system �J Commun'ity system ❑Y Private.❑ Depth to Wafer Table'---'--- ffi: } Character of soil to a depthAof 3.feet: Sand ❑f Gravel ❑ e 5ndy LoamZ—,, Ciay Loam❑ Clay ❑ Adobe E] Hardpan ❑ 8 Previous Application Made: Yes ❑ No,0 . New.Construction: Yes .No ❑l'1kTHA/VA: Yes ❑ No l❑ TYPE OF INSTALLATION AND SPECIFICATIONS:- (No PECIFICATIONS:(No septic tank or'cesspool permitted if public sewer'is vailable within 2004eet.) P �•� � ,'rte Septic Tank: Distance from nearest well-1 »------Distagce-from foundation-/:6,"-----_-,--.Material_�c�__ ______ No. of compartments-- ___._- ' - -Liquid de th-- �'� --- .-:-Capacity z . Disposal Field: Distance from-onearest we4172.--____-,Distance from foundation -----------------Distance to nearest lot line--_.----.----.--. Number,_of lines----I / Length of each line_--1A0- ------- -----Width of trench a•_�_'- Type of filter'maferials��_ �±E_; -_:Depth of filter material 1e --_-F- _Total length_---/o?a------ �::• LL c ', -------------- Seepage Pit: ... Distance.to nearest welt "" ---- Distance from foundation-__._--_ Distance to nearest lot Ime----------------- ❑ Number ofifs - p g material ---------------...Size: Diameter--9--e L--------- ---Depth'-------------------=--------- Cesspool: Distance from nearestwell------------ -- Distance from foundation -_- '' ---.Lining material -= -- --•------ ,..,, ❑ SizeY: Diameter --- Depth- - ' . r ---- ---- Liquid Capacity---- ---- ---- --- -----gals. Privy: Drstance'from riEarest well• -- " y. -+ate" ` ------------ -- -.-- ----..Distance from nearest building* ry : _ _ {-•- --------•---------- rest lot Ime --=- -----=----------`-- _ .wP.�. - :::P- Distance'to nea Remodeling and/or repairing•(describe):---------- -- ----------------------------------------- --------- _ -------------------- - ,, i - - ---- ------------------`---------------------------------_------------------_--•___-___---______-_---__-_--_--__--_---____------_-----_--____-___---.-_-__---------------------------•---__,'------•------•___""�-.:-----_._ t. I hereby certify that I have prepared this application and that the work will bar.done in accordance with San Joaquin County ordinances, State laws, and rules and regulations 6 the San Joaquin Local Health District. ,(Signed].- --^ - sl ---- ''�,1 ------- :------- (Owner .W - r a r Co ract rBy:-------------- --------------------- --•--------- --------------------------------------------------------------------------(Title)-- =. ---------------- (Plot plan, showing size of,lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY �. APPLICATION ACCEPTED REVIEWED BY _ ---------" ----- DAT --- `may� ----------- - - -- " ------- ....:. JILDING PERMIT ISSU_ -ED -------e -. '' _- - ----------- DATE-------------------------------------------------- --------- ---------------------------------------------------------- ----- ------- --------',.DATE--------- ----------teratrons and--or'recommendations•-- - { - ---.--- _ -------------•-•----•----------- - ---------------------------------•----.---.------.----.-------------- --- -----------------------------`---i----- -------amu---:-----r- ---------------------------•------------- -----------•------- ----- r -------------- is , ----------------------------------------------------------------------------------- FINAL INSPECTION KBYi'-- . '-- [ r � Date-= -----------= 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---4-2M . Revises 1.57 F.P,CO.