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(4 APPLICATION FOR SANITATION PERMIT Permit No. IYK (Complete in Duplicate) Date Issued .__�_/_ Application is hereby made to the San Joaquin Local Health District f a permit to construct and instal[the work herein described. application is made in compliance with Qounty Ordinance N JOB ADDRESS ANDL C TZ( A ION ----- ----- --- - --------- ------- -4 ---- ---------------------------------------- Owner's Nam - #c - ------5 - - - - -------1*1--------------_ �-- - _-_-_-_- _7--------�--�---- _ ) Phone ;zeS� - Address----------------------------- - ---- Contractor's Name_ KA --- Phone - -- fe7 Installation will serve: Residence A Apartment House [] Commercial E-] Trailer Court Ej Motel 0 Other ❑ Number of living units: j---- Number of bedrooms ___1_-_ Number of baths -1--- Lot size --- _KJ_Sr-------------------------------- Water Supply: Public system [g Community system [D Private F1 Depth to Wafer Table ST ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe a Hardpan F1 Previous Application Made: Yes E] No 0. New Construction: Yes k' No El FHA/VA-. Yes [1] 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 Distance from foundation---�Q-`____.__.Material-___` 1__' --------- No. of compartments----Y–—--------------- depth_,S-Z..........._Capacity_,Vo__�/ Disposal Field: Distance from nearest weh_./V.V?��Distance from foundation___,----------Distance to nearest lot line---I-0---r ---- Number of lines_____/ — -----------Length of each line-------3-C----------------Vidth of trench._44-- ----------------- Type of filter material Depth of filter material----1-9--------------Total length____ _________________________ Seepage Pit: Distance to nearest Distance f m-fou dation---15v_ Distance to nearest lot line---- Number of pits-- --------Lining materiaL Size: Diamefer_,3�3_1_1- --------Depth-------- ---------------------- :3 J* Cesspool: Distance from nearest well-----------------Distance fro foundation--------------------Lining material__-_____- .__-- ----------------------- Size: Diameter--------------------------------------Depth------------------------------------------------_-Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____---______-_______________________-_. Q_d ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and'/or repairing (describe): ---------- ----- -- -- --------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- --------------- ----- ------ ---------- -------------------------------------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I -------------------_-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepar is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and :, s and eg7ul tions o the San Joai4in Local Health District. (Signed)-----------_-------o. eru - - -------- --- ----- (Owner and/or Contractor) - --------- - --_9 -------------------- --------------- - ---------------- By:------------------------------------ .. .. ...; -----------Z� A '�4 - - - - ----------- -- ------ (Plot plan, showing size of lot, location of system in relation to we is, buildings, etc., can be plat-2on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -I-- --------------------------------------------------- -------------------------------------- DATE.!��------------------------------------------------- REVIEWED BY-------•---------------------- ------ DATE ;.--- ---- tl�-------------------------------------------------- BUILDING PERMIT ISSUED----------- DATE----------vq� Alterationsand/or recommendations:------------------------------------------------------------------------------------------------I......------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ..........;-----------------------I------------------------------ --------------------------------------------------------------------I--------------------------------------------------------------------------- -------------------------------------------------- -------------------------------------------------- --------- -------------------------------------------------------------------- ----------------------------------------- FINAL 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 - Revised 1.57 F,P,CO. %