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S } APPLICATION FOR SANITATION PERMIT Permit No- --------" ----- (Complete -_(Complete in Duplicate) 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. 06-5-- - 65- sf 3 -03 JOB ADDRESS AND LOCAT117N-- ---- /zy' — �.- ` - _ e-(^ �` Phone----------"`r -------•--- Owner s Name_____________ ______ -- -------------------- Address �' 13�: �"v-�3 a-------------•------ ---------------------=---------------------------- -- --------------------•-------- ----•- - ----------- - - - Phone. Contractor's Name-----F-----•------•-- ------- - ---------- - ----------------•------•--- Installation wiii serve:l Residence XT Apartment Nouse ❑ , Commercial ❑ Trailer, Court ❑ Motel ❑ Otherx Number of living units: __-.____ Number of bedrooms __--.--- Number of baths __:_-__I Lot size ` ---- ----------------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Tab4e -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Claya Adobe❑ Hardpan Previous Application Made: Yes ❑ No K New Construction: es No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.)` Aeun�� -" Septic Tank: Distance from nearest well Distance from foundation_.__ _________.Materia-___________________ No. of compartments----------�-------=-Size------- X Liquid depth--------�--- ---------Capacity--- C?a l,/blineT - Disposal Field: Distance from nearest well___��_..._Distance from foundation____;.-__________ Distance to nearest lot ___--_, _._._.. ��- ^' Length of each line hi--------- -------.Width of french----------- ��---------- Type of filter material-----------------Depth of filter material------I��-------Total length_--_----___------- ----------------- Seepage-Pit: DIistance to nearest well----- _______Distance from foundation__;----------Distance to nearest lot line---S----------- N .______-__ {� Number of pits---- --Lining material __ __ - Size: Diameter__33_.'_-- -----.Depth____A_Q_'------_-•--------- I Cesspool: Distance from nearest well_________________Distance from foundation___-_______-_______.lining material________..______"---- ------- El - ----❑ Size: Diameter------ --------------------------------Dept h- -------------------------------------------------Liquid Capacity----------------------------g Privy: Distance from nearest well---:_.----------------------------- ------------Distan e from nearest building------------------------------------------------------------ A- ❑ Distance to nearest lot line--------- ------------=--- -- ------ Remodeling and/or repairing (describe):.-- ----------------------------t--_----------------------------------------- -------)----- -----•---------- " - - ---------- e` "`-- mac'2 /�r - .--- Y x ..� �. '�Y 1 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. (Owner and/or Contractor] ]� =-- --}=- ---=-- ------------------ (Signed ------------- `_;;r--------- ----------------------------------� -----------��I---�.--- -- ---------------------------------- ----------------- - 4 r (Plot plan. showing size of lot,llocation of system in relation to wells, buildings, e`•t�c., can be placed on reverse side). ----------------- rr FOR DEPARTMENT ,,USE ONLY APPLICATION ACCEPTED BY ' ------- - .. - -------------- ----------------------- DATE--------- -------7.--- --- ----- --- REVIEWEDBY-------•----- •---------._ t ------------------ BUILDING --- DATE BUILDINGPERMITISSUED-------------------------- -- -- ' --------------- DATE----------------------------------- ------------------------- Alterations and/or recommendations:--------- -..».....-_... .- ----------------------- --------------------------- ----------- �. ------------------------------------:=-. f ----------------- -------------------- --------------- _-------------------------------------------------------------------- - . .. -� //-/d -�D FINAL INSPECTION 13Y:__ _. . ;� _ _-..1 -=--- ---------- =�--------- Date- ------------- - ----------- -------------- ------------------------•-----• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M , Revisea 1•S7 F.P.CO. : .