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AItIl( 30 rWW ��a 1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicafe) � 0 Date Issued41 '14 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. JOB ADDRESS AN/�D L CATIIJO�N. #03...._/!b!rnv�.. _..-__....._---------------_..-.-_.._--------...------.- ---------... -------- _.. Owner's Name..-__kjAs. :_.�ZI.�C,LrF�- Phone ---- -..-. Address-----...-._.-.-4Kkw...2 ` t'�- ..................----------.... -•-----:1--------...........-------.-_ ----_... _.... yTtrz>� Contractor's Name---- /- ..lfi—..4 ...... Phone...h-��----.x----- -•------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -..:f:.. Number of bedrooms --4te. Number of baths --7-_.. Lot size _? l00-•-------_---•--•-•••••----.-......- Water Supply: Public system 14 Community system ❑ Private ❑ Depth to Water Table _W ff- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe® Hardpan❑ Previous Application Made: Yes ❑ No (a New Construction: Yes 50 No ❑ FHA/VA: Yes❑ No i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ar'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well........d........Distance from foundation....._...........-material...---.....................-............_.... ❑ No. of compartments.........--........-......Size.........................--__Liquid depth-............---------.Capacity....................... Disposal Field: Distance from nearest well.................Distance from foundation.................Distance to nearest lot line...-..._--___- ❑ Number of lines.................... _.Length of each line.............-__----.........Width offrench....................._.-.......... Type of filter material.........................Depth of filter material....-__-_.-T....----.Total length.....................-.........i....... Seepage Pit: Distance to nearest well.,e r. ..........Distance from foundation--0__..........Distance to nearest lot lin.45..----_.._ ` Q Number of pits......I.............Lining material--.'7Rf - .......Size: Diameter--._$?�.p____..-..-Depth_...__'.. s.................... •Cesspool: Distance from nearest well----.......-._-Distance from foundation_---.__.-----_---.Lining material......................._-----_....__ ❑ Size: Diameter.....-----........... ............Depth----------...----- -...------. ......_...Liquid Capacity-------------_. ----.gals. Privy: Distance from nearest well...............-...............................Distance from nearest building-.....-----------_---_-------------------. r] Distance to nearest lot line............................................-......................................................•..........................-.......... 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, and rules and regulations of the San Joaquin Local Health District. ( 9 )...... - - (Owner and/or Contractor) - - By:--•-•---..- -- -- -- - -- - --_ - _- - _(Title)..................- ...................... _ (Plot plan, showing sae of lot, locafic f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-.- ..r.F?�-Ll' _...---------------........-- .......- . DATE ..l`L. L�- l- ----- REVIEWED .._. REVIEWED BY..-----.._.................... .. DATE------ --------••------- --------• - BUILDING PERMIT ISSUED.•_............._...................- ......._..................... DATE...............___................... -..._.._.- Alterations and/or recommendations:...------..-.-------.... ..................-.................................._....----._.....--.......---_._......._.-. - - - -- - -- -- .....-------.... _ ............. ---.............._.. .....__-.._._.--_-1-tit• --._.--. ....................—..............................---_-...-._..-•-_-_•_....._..-......._-.-_--•--....... --..................-.___..-._............. ........'-_-- _-__..._-..-.._•-•..............................._.....•...............-...........-_..........................._.......................-........ . -- raf Y FINAL INSPECTION BY:.---..................----- ----.... ._ ...----- Date-.... - ..- .-.-.-... ... ._.....- • SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oek 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.