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APPLICATION FOR SANITATION PERMIT Permit No. _.1_-0_6 3 (Complete in Duplicate) �•a. 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. 549. JOB ADDRESS AVD LOCATION --------- - _f j 001—0�� ., j ------ wner s Name__ __ ✓t+ y �' Address Phone = r Contractor's Namen. - Phone__._. Installation will serve: Residence Apartment House ❑ Commercial , .- � ❑; Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ .Number,of.bedrooms a2 __`Numbs of-baths _ ---- Lot size__ ___°----_ ater Supply: Public system M1 [D ,Community+system ❑+ Priv�te � Depth to Water Table 3 _ ft. A Character of soil to a depth of]I feet:.-Send JB Gra el ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ ;I j - Previous Application Made: Wes' No ❑ New Construction: Yes ❑ No ❑ PHA/'VA: Yes ❑ No E] TYPE OF INSTALLATION SAND SPECIFICATIONS: ,.., _ (No septic.,tank or.ces}pool permitted if-public sewer is available wi#h—i 200 feet.) Septic Tank: Distance from nearest well__,S- -Q....r Distance from foundation--fQ-----------Material_ "�"" _+` Nopf'com artrrients.x_ - _-- _.. p - _ Size - Liquid depth---- Capad Disposal Field:' Distance from nears t weli4�'-__--:_Distance from foundation IA!___-_----Distance to nearest lot line-JA— Number of lines "- .___ _:_L n th of each line__ "„ _ g Width of trench_ -�------ h:' Type of filter material'" �r Yp --_ _ epth of filter material--_/ __________ Total Iength_-'f_`_O-'______.-_________________ Seepage Pit: Distance to neo est well______________________Distance from foundation___.______-________:Distance to nearest lot line._-____._______- ' ❑ Number of pits--- .VI----------Lining material---------------- ------Size: Diameter-------------_ �, I - ---------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- ❑ Size: Diameter { Depth Liquid Capacity -- ----------------------------gals. Privy: Distance from nearest well_____ _________ _________---------------------Distance from nearest building -------------------------------- Remodeling ------ ------ - ----- --- EJ Distance to nearest lot line___ � --------------------- --------- ' Remodeling and/or repairing (describe)___________________________ ----------------------------------------------------------------I---------------------------------- ' I -----------------•------------ s application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andrule Ihereby certify that I have prepared Ai and regulations of the San Joaquin Local Health District. i (Signed)-- - ----------------�- - ----- --------------------- ----- --------- ----------- ----------------------- --(Owner and/or Contractor) BY:-------- ------------------------------••------------------------------------------------------------------------- ----- ____ ____ - - {Title) ------------ --------- --------- ---------- ------ {Plot plan., showing size of lot, location of.system in.relation.t'o wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- - - -�------- -------------------------------------•--------- - DATE_ -=��' REVIEWED BY------------------------------------------- - *� -- ------ - ---- --------- - - DATE---------- ----------••-------•-- BUILDING PERMIT ISSUED------------------------------ - -------------------------- ---- ----------- -------------- ----------- DATE.----------•--------------- - -------------------------- erations and/or recornmendaf ions: --------------------------------------- ------- ---- --------------- FINAL INSPECTION I3Yl:___ _--•-_- =- ate 9 -- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ; 130 South American Streof 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, CaliforniaR Tracy, California ES-9-2M . Revised 1.57 F.P.CO. d