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APPLICATION FOR SANITATION PERMIT Permit No. .....3 (Complete in Duplicate) Date Issued Application is hereby made'to'fhe San Joaquin Local-Health District for a permit to construct and install the work herein descrilped. This application is made in compliance with County Ordinance No 549 -"W-------------------------------------- ---- JOB ADDRESS AND OCATIOI,�-------- ---------- `----- ------ Phone---- ------------- Address--------- Owner's Narne--_ Yoaxli�;, 74 -----------------S.6 ----- -------------------------------------------------------------------------------- rL Contractor's Name___:__,6111.tZ ------1,7,44--vol----60�1�---?m ap --------------. Phone. -------- Installation will serve: Residence% Apartment Hou;e 0 Commercial 0 Trailer Court [I Motel 0 Other El Number of living units: ---/--- Number of bedrooms _Z--- Number of baths _.1--- Lot size ----42.4�_ 1-07-P------------------------ Water Supply: Public sysfem°, Community system El Private E] Depth to Wafer Table J& ft. Character of soil toa depth of 3-feet: Sand [] Grove] El Sandy Loam 0 Clay Loam 11 Clay El Adobe , Hardpan E] Previous Application Made: Yes E] Nox Now Construction: Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) m, nearest Distance from foundation--. ----- Material-.. Distance fro Septic Tank: A AS7----Liquid clepfh-' /-- -------------Capacity-____5------------- No. of compartments._.__ _-.7—---------Size--J--X---47--x Disposal Field: Distance from nearest well-. ---------------Distance from foundation-_:__f2:__12.......Distance to nearest lot line__xf-------- Number of lines----------/----------------------Length of each -----------------Width of - --------------- Type of filter material-------------------------Depth of filter material-----------------------Total length_-_-----_---_----___--_-___--___-_--.----_ Seepage ength------------------------------------------ Seepage Pit: ..Distance to nearest -----Distance f om foundation----ax!�.......Distance to nearest lot line__'.___.._._ T "M To Number of pits------I--------------Lining material---it"'A----- S;ze- Diameter----- Dept h----- -------------------- Cesspool: Distance from nearest we!!-----------------Distance from foundation_-----------------Lining material------------------------------------- El Size: Diameter---- --------------------------------Depth_--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------_--._-.--___-___--_-_-____._ . ❑ uilding--------------------------------------F1 Distance to nearest lot line----------------------------- -------------------------------------------------------I------------------------------------------------------- Remodeling and/or repairing (describe)-------------------- I--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------I------------------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- -- -----------------------------:------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- ,'-,-I,.here6y 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. - I -MA (Signed)----- ------ --------- - -------CIO,----fnIn-------------------------------------------- �orl Contractor) BY:.......40040C�__ ---------- ------------------------ -----------------------------------------{Title) 4rae0-P,10-' --- - ------- --- ----------- (Plot plan, showing size Of lot, location of system in relation to wells, buildings, etc., can be placed o!n�7reversesild,). FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED BY--- ------------ ------ ----——----------- ---------------------------------------- DATE------------ --------------------- kIREVIEWED BY------------------------------- ----------- ------------- --- -----------------------------------_ -- ------------ DATE-------------- ------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------1- DATE---------------------------------------------------------- Alterationsand/or recommendations:----------------------------------------------------------------------------------- ---------------_-------- ------------_ ---------------------------------I------------------------------------------------------------- ---------------------------------------I- ------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- k ------------------------------------------------------------------------------------------------------------------------------------------------ -------- ------------------------------------------------------------- ------------------ ------------------ ----------------------------------- ----------------I------------------------------------ ----------------------------------------------------I----------I------------------------------ e-�3FINAL INSPECTION BY:---------1111�------------- -------------------------- 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 10-92 Revised W-2100