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a s APPLICATION FOR SANITATION PERMIT Permit No. .__1._.�........ ._- (Complete in Duplicate) Date Issued ... This Permit Expires 1 Year From Date Issued ........ ..../. Application is 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 with County Ordinance No. S49. JOB ADDRESS AND LOCATION..__`a` L___ - �-� r - ---------- Owner's Name-------•---•--------_----_--- _ ------- Phone 4......... Address-------------------------- zz--- ------- -------------- --�---•----- Contractor's Name---------------------- --•--------------------------------•--------------- Phone---------------------_---------- Installation will serve: Residence ❑' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms _Y Number of baths __,�__ Lot size -----------jW X____-�Z-4-1_.______ F O Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AclobeZ Hardpan ❑ Previous Application Made: Yes ❑ No fg-- New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No,j�r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic lank: Distance from nearest well__a.?' ------Distance from foundation____)-_- Materi I__ ______________________ No. of compartments____-____r ___..__Size__., � X* -----Liquid depth----------- -------------- Capacity__.-- d --___. Disposal Field: Distance from nearest well___,tM_Distance from foundation----/_-_-------Distance to nearest lot line___.s�_. Number of lines________-- • -_ "2'—_ _----__{{�__�Length4 of each line------____�-----------.Width of french_-___ _ __z � ___________ Type of filter material_-_A1 _�.epth of filter material____._______p____-_-_Total length_______ ________ lP ______.--.. Seepage Pit: Distance to nearest well---------------------- from foundation-------------------.Distance to nearest lot line_.________..--._ fid ❑ Number of pits----------------------Lining material---------------- ----Size: Diameter-----------------------Dept h...... ------ [ Cesspool: Distance from nearest weil--------_--------Distance from foundation___.__________._-- Lining material________.__._._____._______________ N. ❑ ------------- --------------Liquid Capacity---------------------- ----gals. Size: Diame#er----------�------------- -------bepth----- -- -- ------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____-__--_____________-_-.__-___.__----. ❑ Distance to nearest lot line-- ------------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe)-------------------------------------------------- --•--------- ----- --------------•-----------------------------------•------------------------------- ------------------------------ -------------------------------•--------••--------------------------------------------------- --------------------------------------------- --------------•--------------------------------••------------------------------------------------------------ ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules nd re lat' ns of the San Joaquin Local Health District. 1� (Signed)---- ----- -- - - x--- ------- - ---- -----------------------------------•----------------------------- -----(Owner and/or Contractor B ------------------------------------------------------ -----------------------------------------------------------------(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------- DATE-------------- REVIEWED BY------ ----- DATE BUILDINGPERMIT ISSUED------------------------- ------------------------------------•--------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------- --- ------------------------------------------•-------------------------------- ----- -r-- .- ►Cy D^} '� -----' - ------tom-�-I-- ----------�-`- ---- { A. �d/aGr � LE�I�- ---- - - -- - --------------------------- - ----- -4 "f-� �' ------ -- --- - - ----- � --- --------- ---- ---- ---"" ----------------- ------------------------------------- FINAL INSPECt-I©. BY:.._.. _0 , - �- Date - rf�4 r� "._J ._. 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-9-2 RevisedB-'S9 9Z /r��1,112 JLC