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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ------------- Application -is hereby 'made to the San Joaquin Local Health District for a permit to construct and instl�, the work herein cles`cribed. application is made in compliance with Cownfy Ordinance No 549 - VRJ�o JOB ADDRESS At - Q LOCATION., ------- -- -- ---------- - -- ------ ----------- 4� ---/I ------ ------------------------------------------- - ----- ------ Phone___7___;Owners Name____ 0__ Address---------------------------------------------------- ---------------------- ----------------- ----------------------------------------------------- ----------------------- Contractor's Name.-:y1l.'o--- - ------ ------------------------------------------ Phone - Installation will serve.- Residence E] Apartment House ❑ Commercial El Trailer Court El Motel F] Other )All K_ Number of living units: Number of bedrooms — ----- Number of baths -------- Lot size ....... a,7 C res ---------------------------- Wafer Supply: PuHic system KI Communify system [] Private El Depth to Wafer Table __22 ft. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam L] Clay Loam E] Clay EX Aclobez] Hardpan F] Previous Application Made: Yes Ej No EX New Construction: Yes Ej , No X FHA/VA., Yes E] No NJ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permiffed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -N1P4,P____ Distance from foundafion4Y --------- MaferiaJ_C-4 --- ----- - - --- -------------------- No. of compartments --- 3 -------------------- depth ------ I/ Capacity --- ...... sk Disposal Field: Distance from nearest Distance from iounclat-ionl-_-_5 -------- Distance to nearest lot line__/j0__1 ----- 411 _71-4 ---- --------- Number of lines_---_- --- ---------- Length of each,14_�4047 -- ---- 2 ------ Width of french ----- Type of filter material_____. Depth of filter material ---- j-,9 ------------ Total length .... -------------------------- 1z cam'_ Seepa e Pit- Distance to nearest weII__jt-j4j-_j_& ---- Disfanc f f _:___.Distance to nearest lot line____ Number . of pi e Tr,65TOAU m r ----- --- Depth ----- --------------- ts:--;;b ------------ Lining.m'§terial --- -,--Size: Dia' ete Cesspool: Distance from nearest well-___---_-_.___-__ Distance fr6m foundation -------------------- Lining material___________________.____.-_-____---_- F-1 Size: Diameter, ------------------------ -'---_-- Depth--------------------- ------- : ------- ------------- Liquid Capacity ---------------------------- ga Privy- Distance from nearest ------------------------------ -------- - Distance from nearest building-. --------------------------------------- ❑ V t --- ------------------------------------ Distance to nearest lot line .... ...... ---------------------=-------------------------------------------------- - --- Remodeling and/or repairing (describ ------ fild -------------------------- ------------------- --------------------------------------------------------------- Z:.- ---- - -- 7 ---- ------------------- 2 t ------------ : --------------------------------- -------------------------------- - ------- ---- ----- -------------------------------------------------------------------------------------------------------------------------------- - ------ ------------ --------------------------------- 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 caylHealth �Djisfre (Signed) ---- The --- DAY --- &---MIGHT --- S-eptic-,T-ank --- aarvi_ _e --- - -----1-- ----------------------------------- {ODW. Contractor j J� Ile, By: ------------------------------------------- I ------------------------------------------------------ \ --- --------------- ----- ---------- [Plotplan; showing size of lot, location of system in relation to wells, n be placed on reverse side). P u i FOR DEPARTME�ft USE ONLY APPLICATIONACCEPTED BY- ----- �11 V ----------- --------------------°-& ------------------------------------------- DATE----- - - - - --------------------------------- REVIEWED-BY --------------------------------------------- r ----------------------------------- = (,N--------------------------- DATE ----------------------------------------------------- BUILDING PERMIT ISSUED----------- --- ----------- DATE-- -----------------------•------------------------------------ ---- 1- ------- r Alterations and/or recommenclati ------- if& ons:_ ----------------------------------------------------------------------- ------------------------------------- 4 --------------------------- ------------ --------------------------------------------------------------------- --------------------------------------------------------------------------------------------- L -------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ---------- ------ I ----------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------- -------------------------------------------------------------------------------- - ------------------------------------- I ---------- --------------------------------------------------------------------------------- I -------- FINAL INSPECTION BY: ------L------ ---- -111-9 ---------------- Date ---- --------------------- SAN J QUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES -9-2 M Revised 1.57 F-P.CO. 300 West Oak Street 132 Sycamore Street 814 North "C" Sfr"+ Lodi, California Manteca, California Tracy, California