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vmyrrll,G .__.._- APPLICATION FOR SANITATION PERMIT Permit No. .�.7F..�3� ------ - ------------------------------------------------- (Complete in Duplicate) -------------------- -- This Permit Expires 1 Year From Date Issued Da�� --.tl =-�-�- Appiicafion is hereby made to the San J ui o I h District for a permit to construct and install tth�wo / This applications is made in compliance ► ��ce No. 549. a rk herel r#cribed. ( JOB ADDRESS AND LOCATION........ Owner's Name----- ......... - ---- --------- ------------------- Address_ -------••-------••--- Address--------- � ---------------------------••--------------- ---------------- ------ Phone---nn-� ------------•---------•----------- ----- _Contractor's Name---..-- ---•-------•------------------•-------..........................._........•-- Phone.......... ! Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ..-_V Number of bedrooms _`��-Number of baths J.... Lot size .._ ❑ Water Supply: Public system [3CornrriLnity system'❑ -Pri9atej7Deptli'to WaterTable ........ ft. Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ Sandy Lod-rr❑' Clay Loans Clay _ Y ❑ y ❑ Adobe; Hardpan ❑ Previous Application Made: (If yes,date___________ _______) No New Construction: Yes ❑ No FHA/VA: Yes [] No TYPE OF INSTALLATION AND SPECIFICATIONS: � - —1 - I j (No septic tank or cesspool permitted if public sewer is available within 200 feel:) Septic = Distance from nearest well--------a__-____.Distance from founcl,tion /A _-_..Ma}oriel______________________________ _ ' No. of compartments------------------ Size I - Liquid depth__. Disposal lel Distance from nearest well---_. l7 _Distance from foundation_/Z9 r Capacity -:-___.Distance to nearest lot1ine___. , I Number of lines------:.___ _ ' i � �klstance Length of each line �p _-__Width of trench__--�_See a e Pit: ,a �� --••---•-- - epth of filter mater,al�'_,($_-____--___Total length-___...___f�Q._____- ,_-e of fitter mater � — LY..r,.....-..� ��; - --------•-•P g Distance topearestwelL___ from foundati _#'-:'--___;-__-.Distance to nearest lot line_..___...__...___ Number of its___..____•____,-------Linin material__-_____ Size Di" Lining ametei........................Depth-------------- --------------- Cess ool: Distance from nearest well-------- Distaneb.from foundationy_� _ ____ -•---.Lining material------------------------- `-- - Q I'� ❑ Size: Diameter ----------•----•--- - Depth-:!�__`--•----•------- Priv -------------•------•-Li uid Ca aci -----------------------gal's t y: Distance from nearest well,--------------- ---------------------------------Distance from nearest buildin ❑ Distance to nearest lot line_.. g____ ----•-...... =--- Remodeling and/or repairing (describe):-_____-_-[ � 1 _7i -••---•-------•----------------•----- -••-----•---- ------•--- ---------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law andrul and regulations of the San Joaquin Local Health s District. (Signed)....... ------ ----- -•--------- -•-- -_----------- ------------------- - ------•----------(Owner and/or Contractor) BY: l -------------.(Title) i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY ; APPLICATION ACCEPTED BY___- ` -�J DATE -- ;_ .. ------- EVIEWED BY ----------• - • - ----- - - ------------------------------------------------------------ DATE----- ----- BUILDING PERMIT ISSUED. ' Alterafions and/or�r m .�_ ---•-•-•--•-----•- �- .... ------ • _c.__ _ __f... _ _ __ _________ ___ - - Z- - -------------------------------- .......... ------------------------ ------- ------------------------------------ ------------------------- ------------------------------------------------- --------------------------------------I .____.________- FINAL INSPECTION BY:_-.-_-----.- ----- _�- -----•- ---------- Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wasf 9th Street Stockton,California Lodir California Manteca,California Tracy,California ES 9 gEYl6fa 8-89 2M 5-61 ArLA9