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I/17A, 3-C, APPLICATION ��3 FOR SANITATION PERMIT Permit ...................�. (Complete 1n Duplicate) This Permit Expires 1 Year From Date Issued 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. 544. " JOB ADDRESS AND LOCATION------- ------ ------------ --- ---------------- --------------------------------------------------------- Owner's Name--------- : C--------------- --=--------- --------------------------------•--- Phone,�dJ"%l Address--------------- y r ._.,�2 - /� ------•---------------••----------------------- Contractor's Name c - � ------ � Phone 1 Installation will serve: Residence Apartment House Commercial j ®. P ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-47714umber of bedrooms __7—Number of baths �_ Lot size ____-- _„f' 'f.. ----___-___.___.- Water Supply: Public system JR Community system ❑ Private ❑ Depth to Water Table ?,-Cj ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: Yes ❑ No (Z' New Construction: Yes ❑ No,Q FHA/VA: Yes ❑ No JZ. TYPE OF INSTALLATION AND SPECIFICATIONS: i, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----.__________Distance from fo. t�io - _�-__-_. No. of compartmets__._.__ --...___Size_ __. S Liquid deh___M-a-terial_ Ca acitr[ / r -__----_-"-. Disposal Field: Distance from nearest well--..- --__Distance from foundation_______ --__.Distance to nearest lot line_______ Number of lines------------------ ---------.----Length of each line--------X-e?-----------Width of trench--------2r__._____-____.____ Type of filter material----; GDepth of filter -------Total length_________________ _e ------------ Seepage' 'P.it-: r ', s Distance to,nbarest,well-------------- _----Distance from foundation---%_4".._..Distance to nearest ]of Number ofpits__________ ---------Lining material_____l< ,cG Size: Diameter__.-__ ._--__ , Depth} Cesspool: Dis#ance-from nearest:well-________________Distance from foundation---------------.-__.Lining material-------- ---------- �` G ❑ Size: Diameter------------------ -------------------Depth------------- -------------------------------------Liquid Capacity-- -------------------gals. ,l Privy: Distance from nearest well-____-..____ ______.------,______________D.istance from nearest-building----------------------------------------- ❑ `° Distance►to nearest'lot line._._________ �. F 'Remodeling , and/org (re airin descl' .� nbe) sr'�`-rcpt--«._ -------------------------------------- ------------------- r ..._ _ -•-------------------------"---•------------------------------------------•-----------------------------•-• •-------------.----------•------------ ------------------------ ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cdr fy that l have-Prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Staff law and rufe� regulations of the San Joaquin-Local Health District. <r (Signed), : �-� - :: ------ -----------------------------------------------------------------(Owner and/or Contractor) ;- - . l (Plot plan, showing size of lot, I tion of system in rel'afion to`wells;-buildings, etc., can;be placed on reverse side). E W FOR DEP, . RTMENT USE QNLY APPLICATION ACCEPTED 13Y--____`._____. _._ -- :, --------------=--------------------- DATE----------- - -- ��-- ---------------------------- Z REVIEWED BY f ---------------------I----------- �-`-_ _ DATE .,_. . __.. --------- BUILDINGPERMIT ISSUED -------------------------------------------` ----------------- -DATE_------------------------------------------------------ Alterations and/or recommendations____________________ N ----------------------------------------------- ------------------------------------- ----------------------------------------------------------------•------------------ ----•----------------------------------------------- ------------------------L----------------------- ---------------"---"----------------------- ----•-------------------------- --------------•--- F€NAL INSPECTION BY:. ----- Date---- l.� Z .�� ` ---------------------------------- SAN JOAQU•IN=LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California en,/-6 ,I/r i ES-9-2M Revised 8 'S9 F.P.Co.