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APPLICATION FOR SANITATION PERMIT Permit No. ,6�,2 (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a per7i# to construct and install�fiq work r� c)escrib This application is made in compliance with County Ordinance No'549. B /i1,. �� "- Ana .- ' y JOB ADDRESS AND LOCATION-_ - ,��__ �r y��inn-e_i� C '�__ � TL� YI I------------- ------- ------ 13,06 13 Owner s Name_ T_ Phone__ /__--13, 10 1 Address---------------1.141----- ---- Q- IMContractor's Name---_� _ �Z , _: _ -_ L`-r--'---_-- I'hone . .x�T----4 - ------------------------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑r t n' 0 J� J J Number of living units: __I____ Number of bedrooms�__- N�umber of baths _`;ice- Lot size ____-r�---------------------�_._.:_________._ Water Supply: Public system ❑" Community system ❑ Private J Depth to-Water Table __ -ft: Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ T�Previous Application Made: Yes ❑ No3ZL New Construction:`–YesNo,.❑ - -FHA/VA: Yes ❑• No TYPE OF INSTALLATION AND SPECIFICATIONS. ` (No septic tank or°cesspool permitted if public sewer is available within 200 feet.) I Septic ank: Distance from nearest.well ----- from fo ,,dafion YjO-.. Mat real S� 5� __-_-___.Li uid de th__ Py f Ca acit � _.. h No. of compartments---lz------------'=�--,,Siiz�S- -� -- -- q P ---------� P Y- Disposal Field: Distance from nearest well_Z-U___:-:.Distance from fouadation�_L ...........Distance to nearest lot line-----Ar...... , Number of lines_-'7'�____ Length of each line. :_ _ Q Width of trench____ _ _____________________ Type of filter ma#erial_______ -- --_ Depth of filter material--------------/,?.1otal-- length_1------/_s�Q__o------------------ Seepage Pit: Distance to nearest'we'll-----------------------Distance from'foundation-------__________"_.Distance to nearest lot line_"______________ ❑ Number of pi#s----------------------Lining material-----------------__1�'-Size::Diameter--------_------ �p th P t _ Cesspool: Slista cerfrom nearest well__-��`---- tante from foundation____________________Lining material___.__--...-__--_--__.._--_--_-_-_ € ze{Diameter:'. r __Depth #= 41 = Liquid Capacity - gals. - i # Privy: Disfance from#nearest well----°;'------------------------ -----------------Distance from nearest building-------------------------- __________-- ❑ Distance to nearest!lot line------'------`_------.---- ---------- ------------------ -- ` jii- Remodeling and/or repairin describe - --------------------- E Y_ --------------_- ---- ....._. . � -- , __ t - -- - - -- -- ----- t _...--------'---------------------------------- 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 Joaquin Local Health District. = -Q: 1 06-- - ------------------------------- Contractor) BY:-----y # ' {Ti+le) -- --------------------- ----------------- (Plot plan, showing size of lot, location of system in relati wells, building etc., can be placed on reverse side). i F DEP RTMENT USE ONLY APPLICATION ACCEPTED BY----- --- -- -- ---- -- ----- DATE------J` --.� ------------------ REVIEWEDBY----------------------------- ---------== ------- DATE------ --------------------------------•-------------------- BUILDING PERMIT ISSUED - DATE---------------------------- - Alterations and/or recommendations-------------------------------------- -----------------------------------------------------•-------- ------ ------------- ...........--------•• ----------------------------------------------•-----------------------------------------------------------------------------------------•--•----- --------------------_------------------------------ ---------------.. a i -------------- ---- - --------------------- -------------------- ----- - - ----------------------------'-------T-- - - Date-------------------- ----------------------------------------------------- FINAL --------•--------------- . --------•--•-- FINAL INSPECTION BY---------------u--------- ------ -- ----------------?7/ ----------------------------------------- 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 . Revised 1-57F.P.00. s