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4MIS APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) " Date Issued ____�fl(__ Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ `�- --Z- - '-41� -- ------------------------------------------------------- Owner's Name_ -)-9-------------------- - ------------------ -- ----------- Phone------------------------------------ y I { �t1-- - Contractor's Name----------------- ] ---- ---------I--------------------- Phone---------------------------------- Insfallaflon will serve: Residence (/Apartmenf-House ❑ mmercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --1-- - Number of bedrooms!___1___- Number of baths ----I--- Lot size ____716-1 __l---__________________________-_ Water Supply: Public system [.� Community system ElPrivate E] Depth to Water able -------- ft. Character of soil to'a depth'of 3.feet: Sand/E] Grayel.[I Sandy Loam ❑ Clay,Loa m ❑ Clay ❑ Adobe 12/Hardpan ❑ Previous Application Made: Yes ❑ No &f:New Construction: Yes ❑ No ER/FHA/VA: Yes ❑ No [if TYPE OF INSTALLATION AND SPECIFICATIONS: 1 { (No septic tank ar`cesspaol permitted if public sewer is available within 200 feet.) ' 1 I fzn� Septic,Tan Distance from neareS4_w41____ _L Dist nce frpm founds ion___ _D_____._____-Material___ _ _ _ No. of compartments....,-V--------------Size�7�_ X_ Liquid depth_--- ---------------Capacity- Disposal apacity--- i- Disp so al Field; Distance from nearest well,N.,______-Distance from foundation_____________1-----Distance to nearest lot line----------------- El Number of lines---------------------------------_-Length of each line:''-------_____-_____._-_____Width of french._________._______---________.____ Type of filter material------------------____-Depth of filter material----------------l-____Total length------------------------------------------ Seepage Pit: Distance to nearest well__--------------------Distance from,foundation__..-__------__Distance to nearest lot line------___________ ❑ Number of pits----------------------Lining material--------------------'-:.Size: Diameter------------------------Depth---------------------------------___ 11 Cesspool: Distance from nearest well_________________Distance.from.foundation._..______________.Lining material___.______------- _______________. RQ� l ❑ Size; Diameter----`----------------------------------De th--------------------__- -__ -__ - - Liquid Capacity i P -- - - -i----------- q - -----------------------gals. r (' _ Privy: Distance Brom nearest well-------------------------------------------------Distance from nearest building-------- ------ v [❑ Distance to nearest lot lire_________________________________ i Remodeling and/or repairing (describe):---------------=---------------------------------------------------- ---------------------------------------- V� ---------------•--------------- ---------------------- ----------------------------------- ------- - ------ - --------•----•------------------------------------- -----------------------------•---------------------------------------------------------------------------•-----=---------•-----------------`--•---------------------------------------------------------------------------- 1 hereby certify that I have repared this applicatioriand that the work will be done in accordance with San Joaquin County ordinanc nd es a tions of the San Joaquin Local Health District. )� (Sig d _ 11z - ------- -------- I----------- --------- --------------- (Owner and/or Contractor) By=------------- ------------------------------- -••-------------------------------------------------------------------------- (Title)----------------------------------------------------- (Plot plan, showing size of lot; location of system in relation to wells, buildings, etc.;can 6e' placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - ------^ .�- _------ ------------------ -------------------------------------------- ------------ DATE -----------•--- --- -- --------------------------- REVIEWED BY -' DATE------- �� BUILDING PERMIT ISSUED --- --- DATE ---- - ------------------- - Alterations and/or recommendations------ -------------------- ---------_._ _ __ _ ---------------------------- 7---------C1 - -------Q_13 � __y�------l1 4 ------ ---AF RI; -------110 --------------------- -- ------- ---------�J-4-1—---•CHA_f1b �------- --------Pht)NIF---------------reT> : - ;� g=;� ----- -------------------------------------- - --------------------- --- --- -- -- FINAL INSPECTIONDate _. i � ---------------- 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--9-2M Revises 1.57 F.P.CO.