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�r p� APPLICATION FOR SANITATION PERMIT Permit No. ��.... (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 No 549r7 . JOB ADDRESS AND LOCATION _ .. € � f� V4 o7• 0 Owner's Name--- l-V-t--:- ----- --------- ?-& ------- e lf' r Phon Address----••----------------------- ---- 1 - - ---------------ml-/----------- ----------- -- Contractor's Name-- - - ---.-- { s --------------------------------------- Ph e '� A artment House Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Installs+ion will serve: Residence �p ❑ � Number of living units: __ _- umber of bedrooms -`_-_ Number of baths _/____ Lot size -.5--0--"---Y ---- --- -------- q Water Supply: stem Community system Private Depth to Water Table s Pft. PP Y: Publics Y Y t Y ❑ ❑ P � Character of soil to a"depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ o Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ®-New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pu c sewer is available within 200 feet.) t _. oma_.._", . ,� �.. ., �_ ... ,..7.- ------- Septic Tank: Qistance from nearest SIL: Distance from found ti n_________________.Material___ ____ P No. of compartments Size '~ �� i uid de th_�If r ----Capacity___ __ � . p '------------ q P. Disposal F'.e d: Distance from nearest welt. '-�/_.._.Distance4sn foundation.--/_ __ Distance to nearest lot line----- P 10, ----Width of fi•ench.._� !F Number of lines-----i`�"_'------------- - ----Length of each line- 0______-- -�� ---�------ -- �� Type of filter.material _. / Depth of filter material___._ �C_-_____._Total length___ ----------- -foundation __________ nearest lot line Seepage Pit;Pit: Distance to pits, !I-___-____�.___ _9 Qistancom fou�ndation-----------------.__.Distance t°Depth_t___.__________________________ Number of its______________________Linin material____._ :Size: Diameter-___.______ _ _ _ _- } I Cesspool: Distance from nearest,swell___#_________._-D,istanc fFro`foundation___-_-______.____.Lining material__________________.______________---- ❑ Si � y - -- ------------------ Liquid Capacity --------------------------gals. �^. c::. —arm e:..Diameter__ Depths - I P`riVy: Distance from In ea rst;well-- ------------- --M1_____._.__.----~-------Distance from nearest building------ -------------------------------. Distance to nearest-lot line__.!------,_ -__._._ Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------•-•------------ ------------------•-------------.-------- __________________--_______4__._______________________________________________-__________________-___________-____________________________-_____.____..____._____________-_______---k------------------------ ------------- I hereby c rtify that I have prepared this application and tha th work will be d e in accordance with Sen Joaquin County ordinances, State lav� r�s ons of the San Joa in L 'al ea th s rict. SEPfiC =FANpsyst U --------(p�e�r Contractor) (Signed)----- 2905 . B - - ------- = i+le] . ----- Y:------ - (Plot plan, showing size of lot, lots ion em in relation to Is, bui 'nos, etc., c be placed on reverse side). FOR DEPARYYAENT USE ONLY , APPLICATIONACCEPTED BY-------•--------=------------- ------ - -------------------------- --:--------------- DATE-----------------------��----�J---------------------- REVIEWEDBY------------------------------------ --------------------- --- --- -- ---•------------ DATE---------------- -} - - --------------•------ BUILDING PERMIT ISSUED-------------------------------- yt DATE / / Alterations and/or recommendations:------------------ -- --------------------------------------------------------------- ---------•--- . ••-------------------••---•--• --------------•-- ---------------------•----------------------------------•--------------------------- -------------.--------------------------------------------------•-------- ------------------------------ t ---------------------------•--- ---•----------•------------------------=---------- 117 aw l .rte- '�'• . 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-4-2M Revises 1-57 F.P,M