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1' APPLICATION FOR SANITATION PERMIT Permit No. ._J'`..-.*-V-_"_.9_U_.- �. (Complete in Duplicate) Date issuedApEA is hereby made to the San Joaquin Local Health District for a permit to co g d stall they lrk erei -'desdribed. This application is made in compliant th Coktnty Ordinance No 549. , ll cam. 'd� I JOB ADDRESS IhD ZLCATI�O --- --------_--- - --Owner's Name-• - Phone- e -- _ Address- '.� ----------------------------------------•-------•• Contractor's Name ----------------------------------------------------------------------------------------------- --------- Phone Installation will serve: 11 Residence - Apartment House [:] Commercial ❑ I r Court ❑ Mot9l ❑ Other [3 Number of living unifs: ;/Zmmunify mber of bedrooms __ Number of baths _- Lot size - F'19-_Water Supply: Public:system system ❑ Private 0 Depth to Water Table,`------ ft. �- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loamii E] Clay ❑ Adobe LJ Hardpan L]Previous Application Made: Yes ❑ No E?( New Construction: Yes ® No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank;or cesspool permitFed ' blit se r is available within 200 feet.)t Septic Tank: Distance from nearest well _- -'�ista from fnda ' n__ _:__:____.Mate i � 4----Capacif�y-��-- --- - No. of compartments__-__. _- �+_19-rX 5 iquid d pth_- ----- - �ize__ ------ -- �-----�fq--Ir-.Width Disposa Field: Distance from nearest w I . __ Distance from foundation-_ ____ tante to nearest to fin _" Number of lines----- -"_-- ----------" ength of each line---------1 of trench --"--_-�Type or filter materi _ _ _. .._.�L pth of filter material--__.__ Total length ` �- --------•I Seepage Pit: Distance to nearest well_____________ -- ____ Distance from foundation________ ___.Distance to nearest lot line_-____.______; ❑ Number of pits------- --------------Lining materia;---------- -----------Size: Diameter----------------- De th- Cesspool: Distance from nearest well------------ Distance from foundation---------------------Lining material--------------------------------- ❑ Size: Diameter ------------- ------------------Depth----------------------------•---=- ---------;-----Liquid Capacify-: -------------------------gals. w Privy: Distance from nearest-well_----------_____€___---_.__'--_-- ----._Distance from nearest building_r_____. : ❑ Distance to nearest lot-line___.°.__ ., . ...TMn.. , Remodeling and/or repairing (describe):---------------------- 7 --------------- ----------------- .-----•-- -------------------------------- ----------•-------------------------•---------------------------------""----•------------------•--------------------------------------------- I hereby cerfify-that I have+prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafflaws, and rule egulations t of the San Joaquin Local Health District. i (Signe err ------------------------------------------- ---------------•-------------------(Owner and/or Contractor) Sy:-------------- -----: ) ! 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_l -------------------- -------------- -------------------------•--------- - 14 REVIEWED BY--`-=-- `----------------------- --- - DATE----- f3UILDING PERMIT ISSUED - ---------- DATE----------- -------------------- rn _y- tions a _ .re m�nd s:_. - ---•-----------•------------------------------------- -- •------•--------- ------------- ----------------------,--------------•-----------(/------...-�---••--•----------•--••-----•-------------•---------------------•------------ ______________________________________F_________.______-__________._.______. ------1=f O / ______...__________Y_..__/Cy"___.__F------------------------------------------------------------------ --------------------------------- ________________________________________________________________________ _______________________________ _____._____.___-.____""_-_________-__._______-.__________________ - _ ._""_________________________________._.-__.__________.._______. ._____.._..--.________.___. ________--_. Ic FINAL INSPECTION BY:= .".. . -" - ----=- Date_.."_-_..y = � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi; California Manteca, California Tracy, California ES-9-2M Revised W-2100