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APPLICATION FOR SANITATION PERMIT 6 rmit NoC5-L11_/-. (Complete in Duplicate) n � - Date Issued _____-_" 28. scion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri -pplication is made in compliant 0 ith County yyfOrdinance No. 549. dd- JOS ADDRESS AND LOCATI 4-1--rte !` --W --- -`- !` � Owner's Name----------- _. �` ��r�L„1 Phone "7c�s/ Address..... --------------------------- -----j 1_Q...._.-_ �� =•`�----------------------------------------------------------------------- Contractor's Name----------__----.�� ` �.�.��a"�h�''_�--� owl ---- --r..�' Phone �= fn-01P Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: !e____ Number of bedrooms %3--- Number of baths __Y Lot size —__�________________"- Water Supply: Public system ❑ Community system '❑ Private X Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®'f Hardpan ❑ Previous Application Made: Yes ❑ No 5' New Construction: Yes-moi No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well) _-_Distance froiQn� foundation_�©�______.Materiai__4------ �_ -S1z oZ"�Jr_ "' _Ca acit 1QOG1_� No. of compartments--+�---------------- �----------- ------------ Disposal �--Liquid depth-��------------- p Y -- p r � / Dis osal Field: Distance from nearest well_..."Dis nc from ou ation___"_ _ Distance to nearest lot line"-.-____/, r, Number of lines___s�---_____ Length of each line__�Q�__�r111".__-Width of trench____t7�_ -�-'______________1 Type of filter mater--sal__ .17-_________ __ Depth of filter materia --------- J_!!__Total length_______f s3_'___________________ Seepage Pit: Distance to nearest well_________________ ..--Distance from foundation----------..--------Distance to nearest lot line______-_-____ ❑ Number of pits----------------------Lining material-----------------------Size. Diameter------------------------Depth-----------------------___-----__ Cesspool: Distance from nearest well-----------------Distance from foundation--- ----------------Lining material-------------------------------------- F-1 ____________________-"___-- -.❑ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.________________-_.______-_. ❑ Distance to nearest lot kne------------------------------------------------------------------------------------------------------------------------------------------------ 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, an�and regulatio s of the San Joaquin Local Health District. (Signed)-------- ---4___ (_ 'E"--- -- - ------ - --------------------------------------------- --- 4 r Contractor) , B (Title)- IQs— �"--- ---------------- 1 (Plot plan, wing size of lot, location of stem in relation to wells, buildings, etc., can be p aced on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY-- - ------------------- ---------------- DATE---- REVIEWED BY---------------------------- - ---- --------------------------- - ------------ DATE-=._dam-"------------------------------------------------- V ---------- ----------------------------------- BUILDING PERMIT ISSUED DATE lI' - Alterations and/or recommendations:---"---------L----------------------- ------- ------------------------"-------------------------------- ------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ----------------------------------------------------------------------------------------------------------------- ------------------------------- F 1611 FWAL 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 8-51 Revised W-2100 r