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�e APPLICATION FOR SANITATION PERMIT permit No. ..._E'G...7------ - (Complete in Duplicate) ¢ Date,lssued .__.- -_ -----! Application is hereby made to the San Joaquin Loc Health District for a perm to�con.nstr ct a d 'n stall the work herein descfibed. This application is made in compliance with CoinyO dinance No. 549. 8JOB ADDRESS LO _ TI 5 '� �---y Q 'Owner's Name--- rV--- _ �- 14 + -------------------------------------- Phone bl "# 4 ! Address-----1't� ...� 5 �:---- --- ------------------ ------ -- -----------------------------------------------------------------•----•----------------------------------------------- Contractor's Name , - Phone = ------- Installation ---Installation will serve: ' Residence Apartment,House ❑ Commercial ❑ Trailer Court ❑ Motel [� Other ❑,,_. Number of living units: ---t--Number of bedrooms Z-.—Number of baths ----k-- Lot size --,�_--/-f-_ "�_ .__ "�--_-_.._.-_-_--._ Water Supply: Public system El Community system El Private Depth to Water Table 4-- ff. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [ /Clay ❑ Adobe — Hardpan ❑ Previous Application Made: Yes ❑ f No New Construction: Yes [v�No.❑- SHA/VA: Yes [ No s TYPE OF INSTALLATION..ANA.SPECIFICATIONS;-.-" /� (No septic tank or cesspool from permittediaif-p��5e D i ravailable within 200 feet.) _ (/�) Septi 'Tank- Distance nce from foundation__---- �'------.Material_-_l.._�r4l�.i.!�.r------------------ No: of compartments-------�------._---Size-_i __ -QC .---Liquid' depth-------�---......-__Capacity---.. ' _-- Dis a al Field: Distance from nearest well---- . ;* I p __.__.Distance from foundation____.Q_--_---.Distance to nearest lot line of lines____::___,___-__--:_-__..__Length of eac(a line_-______ _�-% _ _ Width of trench______-�------------------ Number ___I_ Type of filter. material._-.__ _ .. Depth,of filter material-_:_ _- -------)�------- Total length------ --- Seepage Pit:-- Distance to'nearesf well_._=_.__'=___.____'Distance from foundation--------------------Distance to nearest lot line--_--------'t-___ Number of pits=--------------------Lining material ~R Size: Diameter-----------------------.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------..___._._-_-------.--_------ _ ❑ Size: Diameter.--------------------------------------Dept h------------------------------------------------------Liquid Capacity- - ------------------------gals. C Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building_.__-___--.-__--------_-----__----. _ ❑ Distance to nearest lot line-- --- ---------------------------------------------------------------- --------------------------------------------------------------------- Remodeling and repairing (describe)-------------------- -----------------------------------------------•-•--- --------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 havT red`fWi as applicat on and that the work will be done in accordance with San Joaquin County ordinances, State I �v-s; and ulere ulations of he San Joaquin Local Health District. ` - • y; e- [Signed}." -- • ---- �----------------------------- ------------------------------------------------------ ff (Owner an /or Contractor) 1 By-------- ---------------------------------------------------------------- ------------------------------------------------------(Title)--------------------------------- ------------------------------ (Plo+ plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ar APPLICATION ACCEPTED BY-.-- DATE- -------=' REVIEWED BY ------------------------------------------------- DATE --- �„ ------ -•.- BUILDING PERMIT ISSUED------------------ --- - - --- --------- ------------------------------------ DATE.---------------------- ---------- -------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------•----------------------------------------------------------------------------- ---------------- ----------------------------------------------------.............------ --------------------------------------------------------------------------------------------------------- ----------------------------•--------•------- FINAL INSPECTION BY:---------- �" Date------- x"b }-------------------------------------------------- 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-9-21A Revised 1-57 F,P.CO.