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Permit No. _ ...__. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) �3 S Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tFie work herein describe This application is made in compliance with County Ordinance No. 549. Dh ,41// n,eeym iP ZAC-A owats," lk f JOB ADDRESS AND��rLOCATION___._ _g __. _____./L_JI-J -_ �___---_='.__�__"�___.___J_�6?_ t/j_ ✓ 4C Owner's Name------11l0-b-e-'e t"------�'.. L..II.L _�1'f------------------ ------------------------•--- Phone-., -/------Y-714= � 2* / ..�. �'t__U .� ��_04**FApartment ---------------------------------------------------- ---------Address---------- ---Contractor's Name---- k l �� - Phone�!'1"Q d/Installation will serve: House E] Commercial E] Trailer Court E] Motel E] Other F]Number of living units: ---I--- Number of bedrooms _-i-_-- Number of baths __ -----Lot size -----S - �QQ.� "-------- 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 ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [ o ❑ FHA/VA: Yes ❑ No [�- � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` Septic Ta Distance from nearest well-Kilmd---Distance from fo??und�� on__�.�. Material... � -�rl No. of compartments-_.2 __------_____-Size_�____ _dt.___Liquid depth___> ry._____Capacity________ Disposal Field: Distance from nearest well_ t'lSA..._Dista?c� frofoundatio ...J.q!-------Distance to nearest lot line........ �►,/' Number of lines----- --__1h.-Length of each line....... ___ Width of trench _ ��_ ----- Type - �. Type of filter material. _ ______d_.___. _Depth of filter material______ �I Total length-___ __ _-__ __ _!o__.__ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line--------.__-____ ❑ Number of pits----------------------Lining material----------------------- Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______________________________________ ❑ p ------------------------------------------------Liquid Capacity------------ ------ gala" Size: Diameter--------------------------------------De th--------------------------------------------- Privy: Distance from nearest well------------------------------------------------- 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 laws, and rules and regulations of the San Joa ocal Heal District. Si ned ``�� ,1Vy_ _---+--- -- - q ------- a 'a' V' - ----- ( 9 )- �-1- �� .7 1 � --- --- ---- ---------------------------------AQs�rs Contractor) By:------------------------------------------------------------------------------------------- - - --------------- ---(Title)--------------------------------------------------------------- O (Plot plan, showing size of lot, location of system in relation fi ells, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE=0 Y APPLICATION ACCEPTED BY ----- ------ -- ---- -----------------------•--------------- DATE---------------- : - -------------------------------- REVIEWED BY------------------------------ ---- ------------------------------------------------------------------------------------- DATE-- ----------------------------------------------------- BUILDING ------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----- ---------------------------------- Alterations and/or recommendations: ---------------------------------------------•---------------------- ------------------------------------------------.........-----------------------•------••------•----------•---------•----------•-••---------------•- ---------------------------------------------------------------------------•---------------------------------------------•----------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --- -------------------------------------------------------------------------------------------------------- -------------------------- 15 o r� FINAL INSPECTION BY: - ----------- 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-9-2M Reviseci 1.57 F.P.CO.