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---y II APPLICATION FOR SANITATION PERMIT ..._ Permit No. . !(--s- (Complete in Duplicate) TM Date Issu I�d -' I I! Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San q This application is r made in compliance with County Ordinance No. 549. i ---- -- -------. :,r : L✓.. .'--_ .----- JOB ADDRESS AND LOCATION � �► Phone_._--- •---------------------------- Owner's ---- Owners Name-------------- ,. f Address l d��--------••--•.1!_t- ---------------------- ------ -- Phone.----�I�------- 1 G�ft.lJ/f4.O Contractor's Name________________`..___--.-.-__----- - - ----------------- Other Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ / . O r ---------------------- __-_-- Number of baths - .__--- Lot size ------5�--------------------------------------------- Number =-•----- _ if _ - Number of living uni i�: -------- Number of bedrooms ._ I I Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water'Table ________ ft. a - ClLoam E] Clay ❑ Adobe❑ Hardpan ❑ Character of soil to a depthl of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y Previous Application Made: Yes ❑ No T-1NewConstruction: Yes L� iso F1 TYPE OF INSTALLATION IAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ll' Distance from foundation_ -10----------Material___ a Septic T k: Distance from nearest well ' CapacityT - No. of I`ornpartments-- --y-- ------------Size-----•y y`� K �� Liquid depth ----y- � r Dis osal field. Distance from nearest well------ Distance from foundation-- - ---------- Distance to nearest lo} lirNe __-------- P Len th of each line-----:-G�------ Width of french------ _*.. ------ Number of lines------. --------------- - g it 1 Type of filter material-_4- -- - 'tl Depth of filter material---- - -------- Total length------- �--• I. oundation___________________.Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well---_-----------------Distance from f T ❑ Number of pits.---------------------Lining material--------------------- Size: Diameter-----------------------Depth--------------------------- - ?M. Cess o04: Distance from nearest well-----------------Distance from foundation_---- -_-_ --Lining material__.I__ —Li uid Capaeity::I�-: Y-------- -Depth.---. = —gals: P ---w---- q ❑ Size: Diameter-=- ==Ih ----- ---------------------Distance from nearest building--------il i�------------------------------- Privy: --------------------- ------- Privy: Distance from nearest well------------------- ----------------------------- -- ---------- ----------- - ❑ Distance to nearest lot line---------------------------------------- ------------------ 1 Remodeling and/or repairing (describe): -----------------------------------------------•--------r::------ !IM --------------------------- ----------------------------- ---- ---------- ------------------- ------------------ -----------1----------•----------------------- ----------------------------------------------------- ------------------------------------------- -- I hereby certify thati,l ve predpareduthis lations�f application Joaquin LocalkHeal{heDistrl4}n accordance with San Joaquin County- { ordinances, Sta# ws, ar. r ,� -------------------------------------------(Owne i and/or Contractor) ----------------- -- (Signed) Tale SY� :. - ... If •---------------------------------------------- - ----------- -------------------------------------------------- -- (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reversei�side). ;o FOR DEPARTMENT USE ONLY �! I /4DATE ^'_- - APPLICATION ACCEPTED BY----------- a_- A--------e_------------ - ------------------------- iI � ---------------------------------------- ---- DATE--------- -----•------'-M- -•----------------•---- --------- --------------- ---- BUILDING PERMIT ISSU- D-------------- -------- - REVIEWED BY---------------'- --------------------- ---•-------- -----------------•. DATE---------------------1-.-----------------------_-------------------------------ED -- i Alterations and/or recor�imendations:-------- =t----•---••----•-------------------- ------------•--•-- -- -•-----•---------------------------------------------- -•------I------------------------ -------------------- -----•---•------ -----------------------I`---------- ----•------------------------- -----------A_---- ' i ------- ----- -------- --------------------- -------------------- ------------------------ Date------------ ------- ----- FINAL INSPECTION I�BY------------------ V -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT Ii32 Sycamore Street 814�"North "C" Street 130 South American Street 300 West Oak Street y'c TreCalifornia Manteca, California Stockton, California Lodi, California i I ES-9--2M 10.52 Revised iW-2100