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APPLICATION FOR SANITATION PERMIT Permit No. ._ a_E! . (Complete in Duplicate) . Date Issued ?_�o22v-• ! �/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the vv fk hereindescr'ibed. This application is made in compliance with County Ordinance- No. 549. , .ZOO '✓V JOB ADDRESS AND LOCATION_g -sl , ,- -- --_-- ,`�----_ --�'i_ _ ._. ,-o •�- - Owner's Name-------•--------------E- -�r_a_X21-Y !_ / - ------ - -- Phone------------------------------------ Address-------------------------- Contractor's Name------------------- ---------------------------------------------------•--------------------------- Phone----------------------------------- Installation will serve: Residence m Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ] I Number of living units: Z___ Number of bedrooms 3--- Number of baths �--_ Lot size /� __-__Y_,�__ ------------ Water Supply: Public system ❑ Community syst Private ❑ Depth to Water Table 4____ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Q Clay Loam ❑ Clay ❑ Adobe❑ Hardpan L O� Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ .No ❑ 3 TYPE;OF INSTALLATION AND SPECIFICATIONS:_.: {No septic tank.or•cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well -----------Distance from foundaalion_&-------------Material ---------------------------- . No, of compartments------91------------Size_��_'�_R�._�•___Liquid d,pt _____________Capacity.. Disposal Field: Distance from nearest well_6Z �Distance from foundation_./)'-.Distance to nearest lot DJ Number of lines_________,3-----___. Length of each line_____ Q____________.__.Width of trench--- - ��__________________ Type of filter material___-------------------Depth of filter material---1----------------Total length-------42.0------------_______ Seepage Pit: Distance to nearest welf---------------_____`_Distance from foundation--------------------Distance to nearest lot line_______._____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---- -----.Depth---------------------_------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__._______________._-____._---_---- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-- ------------------------- als Privy: Distance from nearest well ______________________________._.___.____-__._Distance from nearest building__________._________.------------------ ❑ Distance to nearest lot kire------------------------- 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 Count ordinances, State-laws, and rules.:and regulations of the San'Joaquin-Local:Health District.,_ J[Signed} Q- -------------------- -------------------- •--(Owner and/or Contractor) By:--------------- ---•-•--------------- ------------------------------------=--•---------------------------------------------•----(Title)----------------- --------------------•------------------------ (Plot plan, showing size of lot, location of system in.relafion to wells, buildings, etc., can be placed on reverse side). F TMj=NT USE NLY APPLICATION ACCEPTED BY------ -------------- - --- DATE--- Sa-- -- ---------------=------ REVIEWEDBY-------------------------------------- ------------------------------------------------------------------------------ DATE------ BUILDINGPERMIT ISSUED---------------- --------•------------- ------------------------------------------------------------- DATE---------------------I--•------------------------------------ Alterations and/or recommendations:----------------------------------------------------------------------------------.----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------.------------------------------------------------- --------------------------------------------------.. -_--------------------------------------------------------------------------------------------------------------------•----------------•------------------------------ r -----------------------------------------------------------•-------------------•---------------•-----------•-- -------------------------------------------------------------------------- ------•------------ FINAL INSPECTION BY:---------- '- =----------=-- `------------------ -------------- - Date.-------- ----`--�� - T -- SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street 30D West Oak 'Street r 132 $ camore Street 814'Nor#h 'C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Ravisea 1,57 F.P.CO.