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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) lI J y J } Date Issued s F 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 witc�hh/ Coounty'OrdinaNo. 49. e JOB ADDRESS AND CATION ------ -_'�--_ f �. � f% ------ --•- -- --- --------------- Owner's Na -- -- ^ Phone-- Address. hone- Address- -------- »' x --------------- ---- Contractor's Name--- ' l I je--- --.....-- _ x:?:�� _ p hone � r+ - Installation will serve: Residence' Apa ment House ❑ Commercial ❑ Trail Court[• MoteI Other` ❑ 1 0, - . 1 ,rb r 1 Number of living units: __ ___ Number of bedrooms -.9—'Number of baths _/-____ Lot size ___ ----------------- _________ Water Supply: Public system ❑ Community system El Priva teX4 Depth to Wa.ter TIable �J,ft. 0 Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy �Loam.❑Clay Loam 0*� Clay ❑ :Adobe Hardpan ❑ Previous Application Made: -Yes E] No .New Construction: Lye sX No�❑*—FHk�VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tankr cesspool permitted if public sewer is available within 200 feet.) eptic ank: Distance from nearest well --- ---f_______.__ Distance from foundation ---------- __E----- .Material__---------- ___._._------------------- 1 No. of compartments -------------------------7- Size -------------------------------- Liquid depth ------------ . ___-.___ Capacity -_-------_------------ t Disposa eld: Distance from nearest well__...-* ------ Distanice from foundation ---------- L ------ Distan�e to nearest"lot line_________________ Number of lines ---- ------------------------------- Length of each line --------------------- of trench ------ --------------- .--------- � Type of filter material ------------------------- Depth of filter material ------------- 1_e____Total length_____________________________________ Seepa Pit: Distance to nearest well ---- _.------ Distance from Kundation --- /K_f____.Distance to nearest lot €ine------ ._��___.__ Number of pits___- ----------- Lining material _ ______Size: Diamet dr ��...... _... Depth_____��_/---------------- Cesspool: Distance from -nearest. well________ Distance from -foundation-� � /.Lining material_z ______ ___________ ❑ � Size: Diameter Depth _-------- ----- .Liquid Capacity --gals. Privy. -Distance from nearest well_________________ ___ ______ __ ____ __ Distance fro. m nearest,buildin-9,_>_--------- ._ _�___---- ________.._. � ❑ Distance to nearest lot line -------------------------------------------- -------------- i } _ -----•-•------------------------- --:------- ------- �- ------ a repairing {describe ---- --- .Remodel :\ s cJ t. ---------------------------------------------- ----- ---- - _------------- - -- - -------- --- -------------------------------------------------- r I hereby certify that I have pre red this applicat' n and Ahat th we ork will be done 'in accordande •wifh San JoaquinlCounty rdinances, Sipfe lalwsi �rnd ruljo ay�regulat�s of San aquin LotallFjealth District;. —�_____________ By:_ ------------------- --- ------ - -- -------------------------(TT {Plot plan, showing size of ot, I c 'on o syste r io� to wells, buildings, etc., can I FOR DEPARTMENT USE ONLY ---------------------(Ow nd/or Con#ractor) ! pl -ce� `� d on verse e). APPLICATION ACCEPTED BY ------------ --DATE - -,�'"� . ------------- REVIEWED BY- ` DATE •-------------------- - BUILDING PERMIT ISSUED__.. t ----------------- DATE Alterations and or -recommendations:--.}----------------- -------- - ---------------------------=--------------------------- ---------------------- ""`# ------ ...-""_-_------------------------- ----- ------ ----- .,---_-----------------------•-----------•--•--------- - P , --------------------------------------------------------------------------------------- ------------- FINAL 1NSPECTION'BY_ __________"Date Y ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi,-Californie Manteca, California Tracy, California E$ -9-2M , Revised 1.57 F.P.CO.