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APPLICATION FOR SANITATION PERMIT Permit No. L__�. ilo_------ P (Complete in Duplicate) G / i1;. Date Issued ______ i Application is hereby made to the San Joaquin Local H alth District for a permit to construct and install the work herein described. This applicatiori ismade in o Iia ce ith C u Or� inance No. 549. /�6 Q `1 JOB ADDRESS AND LOCATION- � ------ - ---- -------------- ' ' ------- ° � / r� Owner's Name---'-*7 -----�- f q;----- '``��` Phone =_ Address--- t_.1�� ------1-/----------- -- --------------- --------------------------------------------------------------------------------------------------------------------- Contractor's Name ------------------------------------- ----------- --•--- Phone----------------------------------- Installation will serve: Residence ❑ Apartment Hous ❑ Commercial,20 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedroo -s-------- Number of baths____ Lot size __�x.�-3___a_'___�___?'______________________________ Water Supply: Public system ❑ Community system Private N Depth to Water Table ____ ft. n Character of soil to a depth of 3 feet: Sand ElGrav I [I Sandy Loam, Clay Loam (] Clay [:] Adobe [3 Hardpan ❑ Previous Application Madei Yes ❑ No bR New Construction: Yes jM Not❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`c Se tic Tank: Distanc�sspool permitted if public sewer is available within 200 feet.) pp p e from nearest well_-__L_b-------Distance from foundation-_ _____Material____' _----________ No. of"compartments------ --------------SizeA'S_` __"- .*3t_.--_Liquid depth--.---- •._ ��-----Capacity_/ __- -- Disposal.Field: Distance from nearest well 9 ______ Distance from foundation_ _______-Distance to. nearest lot line_________-__ (� Number of lines______ ----------- Length of each line_.-44--Z------------------Width of trench...._ _____"------------- Type __________`T e of Cter materia - _Depth of filter material---ly_ ___Total length-- __ 4"b Seepage Pit: Distance to nearest well____________________Distance from foundation__-_-:"____._____..Distance to nearest lot line---------------_ El Number of pits----------------------Lining material--------------------_-Size: Diameter-----------------------Depth--------------------------------- Cesspool: -------------------------------- Cess ool: Da nearest wel __-__________ _Distance from'fo�ndation.___-- Lmaterial______________----------------------- El ____----_ --- - ❑ �+_ .eDiameter - _ De-Depth-.t_ __________________� Liquid Capacity __gals. �l r 4�__ -------______.'-Dista'rice`f(om nearest building Privy: 1— Distance-from,nea rest t well'__. y----------- �-- 9------------------------------------------ ❑ ; Distance to nearest lot line--------------- ---------------------t --fE :A------------------- --------------- --------- Remodeling`and/or repairing (describe):------------------------------------------ ------------------------------------------------------r.------------ •----- - ------ = ----------•----------------------=------`-------------_------------------------------•--------•------•----- ---- ------ iM - •------------------------------•------------------------------- --------- -- ----------------------------M------------•-•---------•--•------------------- --------------------`------------------- I hereby certify that 1'1have prepared this applicati n and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and regulat ns of theSart Joaquin Local Health District. 1 (Signe _ _ _ ( / ) - - -- --- -- ----- - -- -- - - - -- --- ------------ -------------------------------------------------------------Owner and/or Contractor 1 Title Y 1 (Plot plan, showing size of lot, location of system in rely ion to wells, buildings, etc., can be placed on reverse side). FOR C EPARTMENT USE ONLY APPLICATION ACCEPTED i3Y- ---- - -------------------------------------------------------- DATE-----4-_477r7--------------------------------- REVIEWED -------------------------------- REVIEWEDBY-------------:-----'----------------------- ----------------------- -------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------ ---------------------------•------------------------------------------ DATE----------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------•-----------•----------------•------------------------------------------------------------- ---------------------------------------------=----------------------------------------------------------------------------------------------------------------------- -••-------------------------------------------------- �� . II it i FINAL INSPECTION BYE' SAN JOAQ IN LOCA. HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Sfr4 of 132 Sycamore Sfreet 814 North "C" Street Stockton, California ;fIf Lodi, California Manteca, California Tracy, California I! ES-9-2M Revised 1-5.7 F,P.CO.