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APPLICATION FOR SANITATION PERMIT Permit No. --- 9 ' (Complete in Duplicate) 6 Date Issued pplication is hereby ma- ,to the San Joaquin Local Health District for a permit to construct and install t wo rein described. This application is made in compliance with Coy ty Ordinance No. 549. r JOB ADDRESS AND Owner's Name A^ 1�400Phone Address--.1170--4 - # ............ ---. --- .. Contractor's Name---- �� _ =,-- --! --------------- Phone__ • - c Installation will serve: Residence g �p64ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Ir � Number of living units: _/_-_- Number of bedrooms Number of baths --- Lot size ---- ----- - - - ---------- Water Supply: Public system�l❑ Community system ❑ Private [-'Depth to Water Table i5�� ft. Character of soil to a,depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Mader Yes ❑ . No New Construction: Yes 4-kv-m t TYPE OF INSTALLATION AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) r-•r Septic Tank: ,Distance from nearest --Distance_from foundation__. 6 -- Material ------ [ � No. of corhpartments-------- ---------Size-- -- --- -----Liquid depth------4/ /--------Ca acit �d Disposal Field: Distance from nearest well...?--(P-- Distance from foundation_____. !___.Distance to nearest lot line__--/----- a �.._ Number of lines___.___,/______. _#a, - ___Length of each line__- .QQ_________ _____Width of trench._ ____.- ___" ---------- Type of filter material_ � Depth of filter material-__--- a, Yp � ��----- - ------ ------.-Total length-------�--�--�----------`. ---------- Seepage Pit: Distance to nearest well____________________Distance from 'foul dation/_-_.._______-___.Distance to nearest lot line_____..._________ ❑ Number ofi pits----------------------Lining material--,------------------- Size: Diameter-----------------------.Depth----------------------- Cesspool: Distance fiom nearest well ______-_____Distance from foundation---_---------------.Lining material--------_------------------.- _ _❑ Size: Diameter- _t :_- _--.=:w Depth:P; ;---:_ _ :-_-------------- Liquid Capacity.: w :; gals. Privy: Distance from nearest well___---------- - ------ stance from nearest building ❑ Distance to nearest lot line i` "`'4—' -----. Remodeling and/or repairing (describe)_------------------_--------------------------._ ---------••------- , --------------------•---------•---------------•----..._..---------------------------.---- ------------------- ---------- -----•- -------------•-------------------------------------- ----------------------------------------------------- ---------------------------------------------------- I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Sined -9 ) -- --4""=-------------(Q * Contractor By:._._ - = - ={Title)--------- ----- - ------ (Plot plan, showing size 0;1!lot, location of system in relation to wells, bu=ildings,'etc., can be placed on reverse side). Ik FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BYf-- -------- ---------------------- ----------------- - ----------- DATE- --- - REVl1=WED BY :1i -----f-------------------------------------------------------- DATE--- - BUILDINGtions and/or recommends --- ---------------------- '------------•---------------•---------- ------ DATE--------- ' ----- BUILDING PERMIT ISSUED-_----•;tions:__ �-- - - -------------- ------- il . - ---------- -- --------------------------------------------------------------•------- FINAL INSPECTION = e ------- ----------------------------------- ---- ----- -----��:3 SAN JOAQ 1NN LOCAL EALTH T 130 South American S+reef 300 Wes} Oak Street 132 Sycamore Street 814 North "C" Stir Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 !� IF _ A