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FImo' APPLICATION FOR SANITATION PERMIT Permit No.14/-(---- ------- (Complete in Duplicate) zV Date Issued .---1.____--•----�---- • Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereiP described. This application is made in compliance with County Ordinance No. 549. �4 (;o , , JOB ADDRESS AtJD LOCAT},ON_ _--- - �- _ - -- -----------•----•-------------------•- ---- Owner's Name____ &"'"�!l .-- .00 Zo - Phone--Phone:_-------------------------------- Address 1 }----- ------ Contractor's Name --=------------- -----------------------------------------------------•---- Phone Installation will serve: - Residence Apar-ment House ❑ _Commercial ❑ -Trailer Court_..❑ Motel ❑ Other ❑ �. Number of living units: --- ---_ Number of bedrooms -- umber of baths _1___ Lot size ____ ------------------------- Water Supply: Public system ❑'. Community system ❑ Private, Depth to t�Table -7,a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam Clay ❑ Adobe❑ Hardpan ❑ �. Previous Application Made: Yes No ❑ New Construction: Yes No ❑ 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 ound ion____ i 3t /--------- -Ma real---- ---------------------- No. --- ------------- ------of compartments-------�Y____------Size-------O,�'��c�:---Liquid depth__-------- Capacity--� _6 -------- Di-s osal Field: Distance from nearest well__ 4-----_.Distance from foundation i - ,e_�____--_.Distance to nearest lot line___.j�z_'�.__ [ Number of lines---------I_ ______------ __Length of each line_______t1f__-_ ___._.Width of trench_-.- -Type of filter material--- Depth of filter material__- , -----------Total length_____ CJ__--.- C----. Seepage Pit: Distance to nearest well___®Q'7_Distance�f om�ndafiion_ lam_____-Diarce to nearest lot Ike-________-______Number of pits__-----If-------_____Lining material,_ ameter--.- -------- ----Depth . // p - --- ------ Cesspool: Distance from nearest well-----------------Distang from f ndation_-_ _ -----------------Linin material Size: Diameter----------------------:---------------Depth----.------------------- -L�uid.Capaci�Y_ ��5� � Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building-------------.----- - ----------- - ❑ Distance to nearest lot line Re odeling and/or repairing (cl scribe];V7��4 --------------------------------------------------------------------- * ------------------- �H K------ -,--q------ r. ---------------------------------------- �--------•-----•�-- ----------------------------------••-----------•-----------.......--•--•-----------------•-----------------------•-------------------------------- -------------------------------------------•---•---- --- -----------------•----------•-----------------•-•------------•--------•-•------------------------------------------------------------ --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate laws, and rules pnd regulations of the San Joaquin Local Health District. (Signed).. (Owner and/or Contractor) BY:------------ -----•--------------------------••-•-----------------------------------------------...---------------------------------(Title)----------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --------- = ----------------- DATE REVIEWED BY RATE ------------------------------------------- -- ;= °-BLiILD1NG,fERMIT-I.5SUED----'"--=---- '--__-'�_-"=s=-- �---_------ ------------.".�------------, _ ,--_-- Altera j ns and/or recommendations:___ _ __ _____________ _ - ib ------- ---- _ _ a -o- c------------------------------------------------ ------- ---------- --- ----------- - -- --- -------------------------------------------------------------------------------------------------------------------------•------------------------ ------------- --- - y - - -------------------------------------------------------------------------------- FINAL INSPECTION BY--------------------------- � -- ------ ------ Date------ - - _r 7"" 4i SAN JOAQUIN LOCAL HEALTH DISTRICT 136 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 10-52 Revised W-2100 r„