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APPLICATION FOR SANITATION PERMIT Permit No. .__ _ S. ___ (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 oV111i JOB ADDRESS D LOr rATION_`_�� --L7 �W + Owner's N6;ne--- - ------ -- - �i yI , - -- - -- phone Address---I - ��__ _� _-- z . Contractor's Name --•--------•-••----------- - Pone -------------------- h -------------------- --------------------------- Installation ------- ---- Installation will serve: Residence ❑ Apartment House ❑ Commercial I] TrFailer Court ❑ Motel [I Other R� Number of living yni}s ____ Number of bedrooms Number of.bTr aths _____. Lot size -fin Water Supply: Public system ®� Community system ❑ Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sap y o �Clay Loam ❑ Clay E] Adobe ❑ Hardpan E]Previous Application Made: Yes 0 No-E] NewConstruction: Vs No E] FHA/VA: Yes ❑ No [7] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted iXA_d1Disfan5;' ublic sewer is available within 200 fee).) Septic ank: Distance from nearest wel `a� �jt�frr�a ,foun tion--------- ------ at ri I... ... --:-- ---------- No. of compartments_______ ----- �_____€�:___Li uid c�e t - 11 �� -- Size-------••------ - pacity---= � - Dispos Field: Distance from nearest w II_ _ _ Distance from fcundation_L O Distance to nearest lot line___-�� wt� Number of lines___________ Length of each line__________ 9 Width,of trench------_-_ -- -_-- T e of filter materiLe th of filter material________�_r�� Type p 6 -----Total length---------�r ------- ----•---- eepage Pit: Dis#ante to nearest-we'll--------------_._______Distance from foundation_____--------------_Distance to nearest lot line------.._______- ❑ Number of pits------f---------------Lining material----------------- _---"Size: Diameter----•-------:----------Depth----------------. ----------- Cesspool: Distance from nearest well___________ --_Distance from,foundation-------------------.Lining mate ria l---------------------------------- _ _ ❑ Size: Diameter-------------------------------------:Depth------------------= -------------------------------Liquid Capacity-- gals. r. Privy:. Distance from nearest well--------------------------------------------------Distance from nearest building.____.._--.______________---_ -- ❑ - Distance to nearest lot line------- W __ - �-- - -' ------------ RemodeJ g and or re airing {des :� e):-- _ ------------------------ --------=-I----------------------- _- - ' - t!4�.,P = - - .�. (-- ------- -------------- ----- - ------------------------------------ ---- -------------•----------------------- ---------------------------------------------------------------------------------------•-------------------------------------- I hereby certify fhat 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. (Signed)----4_4....... --' fir'' J. � r' ' ner an �' � - ! &JROw d or Contractor) BY= ------------------------------------------------------------------------------------••------------ (Title)--------- - = ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- --------•------ DATE-�----------------- --------------- ----------------- REVIEWED BY------------------------------ --- � DATE :. BUILDING PERMIT 15511ED ------------------------------------------------------------------- DATE - ------------- .----- -- --------- Altera .stio and/or recommendations.-_ =------ ------ ---------------- -------- - ------ --- - . -- R `-- �-P �,/ __._ a-, --- -- - 774 - .. . `. FINAL INSPECTION BY: I 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 4 'Tracy, California ES--9-2M Ravisea 1-57 F.P.CO'