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�5 'APPLICATION FOR SANITATION PERMIT Permit No..kl �___ (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued ��---- bate Issued _______ ___ Application is hereby made to the San Jo i o 1 Health District for a permit to construct and install the work herein described. This application is made in compliance witho�ty Ordinance No. 549. JOB ADDRESS AND LOCATION-- - --- ------- -----�-#no...--�V.V. --- j----------6--= I Owner's Name------- �.�. _ ------.4v -e_ d -•-------------------------•�--------------------------------- ---- -- . Phone__,......._-•---••-•------------ Address--------------- - -------- -------405..---1�_.Sti �P.>r. •-•--- ----------------------•--------• --------------••------•---------- Contractors Name £JR ----------------------------•-----` •--------7-- Phone.N_Q_ �S_X_2_115 r Insfallation will serve: ResidenfeApartment House ❑ Commercial El Trailed Court ❑ �`'otel ❑ Other Number of living units: _ Nmber'of bedrooms _ Number'6 baths -J- Lot size,____ __._ ______________________ Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy L P m ❑ Clay Loa ❑ Clay ❑ Adobe 21-`Fiardpan ❑ -r Previous Application Made: Yes o ❑ New Construction: Y'es.j�p No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: t '✓ .(No septic tank or cesspool permitted if public sewer is a 11able within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------ ------------------------------ ❑ No. of compartments--------------------------Size-------,i---------------•------Liquid depth--------------------------Capacity------- ----'--------- Disposal Field: Distance from nearest well._�-_____________Distance from foundation=_ '_'.____________Distance to nearest lot line___________.._... ❑ Number of lines-----------=----------------------Length of each.line�---------------------------.Width oftrench--------------.--------------------- CW Type of filter material-------------------------Depth of'filter mater,ial-----------------------Total length----------------•------------------------- Seepage Pit: Distance to nearest well_/jt�hQ_____Distance from foundation---45i -____.Distance to nearest lot line* -------- Number of pits-------- ;_.___.__Lining material 0.. _,__ Size: Diameter_____ _ ________Depth__-__�dn�------------ C Cesspool: Distance from nearest well-----------------Distance from foundation._..-_`.___..._-.Lining materiaf------------------------------------ ❑ Size: Diameter--------------------•--_------------'Depth--------- ----------=--- ------------------ - ----- Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.--- ---__---------.__________.._____._._. ❑ Distance to nearest lot line_----------------------------------------------------------- Remodelin and�in e� 'tel{�9` ------- ----` � `^"�'�------------------------------ I - ------- ---------------------------- ------------------------------------------------------ ------------ ---------------------------------------•-----------------------------.-------------------- ---- ---•-------•----- ------------------------------- 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 r les an 'regulations of the San Joaquin Local Health District. �Si ned . ---------- =--------------------------------------------------------- -------- ------------ `---- ----------------- Owner and/or 9 )---------------------- - - - - - ( Contractor) By:--------------------------------------------------------------------------------------------------------------------------------------(Titlel------ ---------'-------------------- ------------------------ (Plot ---- - ------ --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY----------- ____________ ------------------------------ DATE----- {- -- --- � ---- -------- ------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------- ------------------------------------ ----- Alterations and/or recommendations:------------------- --------•--------------•-----------------------------------------------------------•------------------•-------•-------- ------ i -------------------------------•-------------------•--••-------•------------------------------------ -------- ----------------------------------------- - -•----- ---- --- ---- --- ---------- •-------------- FINAL INSPECTION BY:--- ` r/- ------- -------------- Date------------- <r------ ---- 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 1 ES-9-2M Revlsed 8-'S9 F.P.Co.