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APPLICATION FOR SANITATION PERMIT Permit No. __Sk-__- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application; is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION-- 7-f� . .,�Q_Aw -- - --- Owner's Name tC1�2�L /. --- ---- �s��'�Phone---------•---•----•-.--------- K - -y -- -------------- Address - �7 / -------------------------•--- -------------------------------------------------------------•---------- Contractor's Name------- x/44 -,710 - ---------•'' -------------. Phone Installation will serve: Residence Apartment Hou e F] Commercial E] Trailer Court El Motel E] Other E] z r Number of living units: Number of bedrkims Number of baths _ Lot size _____ __ _ _ __------_____________ Water Supply: 'Public.'system, Community,system ❑ Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;��101 ay Loam ❑ Clay [] Adobe ardpan ❑ Previous Application Made: Yes ❑ No Send Construction: Yes FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200-f � c Septic Ta Distance from nearest II deT X ance�from foun Mater; No. of compartments-, -------------------�a��---�' --- --Liq id'depth---- r---__--Capacit)��.Qd !r � er ___ Distance to nearest of ljn�e___.�Q Disposal Field: Distance.from nearest w II_��w__-. to ce nom oundation__ �__� ��"` Number of lines_____'_______ __ ________ _ Length of each line% d__�Qb____ a__.Width of trench_.____.______.______.___________._ Type of filfer material_________________ Depth of filter material___/!!_____:_Total length__ D r { Seepage Pit: w Distance to nearest well-----___---------_ `_Distance from foundation--------------------Distance to nearest lot line----------------- El ___._ -_❑ Number of "pits--------''-------------Lining material-----------------------Size: Diameter------------------------Depth------.------------------------ --- Cesspool: Distance'from nearest well-----------------Distance from foundation--------------------Lining material-_____._____ ____________. ❑ Size: Diameter_--- ------------------------------Depth----------------- ------Liquid Capacity-------------------- ga#s. Privy: Distance from nearest Well------------------------------------------------- from nearest building----------.__.___________-__-________----. 4 \ Cl Distance-to nearest lot line--- -------------------------------------=--------------------•----•----•-------------------------•-------------------------------------- Remodeling ---------------------Remodeling and/or-repairing (describe)--------------------------------------------------------------------------------•-------- ---------------------------------•.---•-•--------------- ----------------------------------------------------- ---------------------- ----------------------------------------------------------------------- --------------------------------_-----•-------- ----------- - ------------- ---------------------------- ------------------ ---------- ------------------------------------------ ------------------------------------------------------------ I -- ----------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY&NIGHT . ---- --------�oPtjC_T_ank_Sor_vim- /nfo _ Contractor) (Signed) g )Y ------------------ i 20e�So:Eldorado HO 2-7046 B .. ----------- '-eattsa�a}4�a1if:-•------------- (Title) (Piot plan, showing size of lot, location of system in relawells, builIngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - DATE------------ REVIEWED BY-------------`-------------------.- `--------------------------------------- DATE------ ----- --------------------------- BUILDING PERMIT ISSUED______________.__-- Q - DATE--------0. ----- . Alterations and/ r recommendations----------------- -------------- ------- --------- --=------------- ---------------- ----------------- ----- - - ----- --- ----- ----- ------ ----------- '�? �E =�Gt �-C�. _ 1 •----- �_�e ---------------------------- ------------------------------------ FINAL INSPECTION-BY:------ -- - ----- ----------------------- -------- -- -- Date---------9(:- ------ -----= -------------------------------- SAN -------------- --------=-- SAN JOAQ,UIN LOCAL HEALTH DISTRICT 130 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 . Revised 1.57 F.P.CO.