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1l q I Z' sq APPLICATION FOR SANITATION PERMIT Permit No. --•--------------------- . (Complete in Du licate Date Issued - - a -----� � � 3r Application is hereby made to the San with County Local Ordinance iNoc 549-a permifi to construct and install the work herein described. This application is made in compliance Y 30- A4c- tr? JOB ADDRESS AND LOCATIONht------( Phone------------------------------------ Owner's -------------------- --------Owners Name------------_"--- --- -- --- = Address-------------------- - � ---.----- 1 Contractor's Name-------------------- ----- -- ----------------------- -------------- Phone 1t �'- :• ' Motel ❑ Other ❑ Installation will serve: Residence 2---/Apartmen# House ❑ Commercial ❑ Trai//ler Court ❑ �� d cS �. _� Number of living units: _�__. Number of bedrooms 3---- Number of baths _L"____ Lot size _________�___________________ 11 Water Supply: Public system ❑ Community system Z) .Private ❑ Depth to Water Table -------- ft. pp Y' Clay Adobe�ardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑1 Sandy Loam Clay Loam ❑ Y ❑ Made: Yes No New Construction: Yes No ❑ HA/VA:Yes E] No Previous Application Mad ❑ 1. TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or'cesspool permitted if pi is available within 200 feet.) �. Li uid de th-•------��/----------Capacity -- Septic Tank: Distance from nearest well _ :Olsten e f om founionJ___ aten _____ 4 ® No. of compartments----- ---�_Size__ - _ �-- -'_' q p -�--Z Bistance to nearest lot lir�e___�_ . Disposal Field;: Distance from nearest well .. `Distance ff�grsS.fou action_ Width of trench._-" - --� '.!�- --_Length of ieacN l�n "___ --- 9 Number of lines------- ------ - - ------___-.- 1 Type of filter material-5. -Depth of filter material---Total length_-.___ "- -------------------------- Type ----- Seepage Pit: Distance to nearest well______________________Distance from foundation__ _-Distance tonearestlot lineth ----------------- Seepage -._----_-_.- Number of pits---- ------------Lining materiaL_______.._-______--.size: Diameter__ t ❑ Cesspool: ; Distance from nearest well-----------------Distance from foundation-__-----___.__Liquid Capacity_____________._____. ---gals• ❑ � Size: Diameter--------------------------- ------- Depth Privy: Distance from nearest well------------------------------------ Distance from nearest building___--________-.________."--------------- ❑ Distance to nearest lot line---------- ---=------------- ------------------------------------------•---•---- --------------------- - --- II - Remodeling Rand/cr repairing (describe)----------------------------------- = --•--------------------------- --------------------"--------- 1 ------- ------------------------------------------------- 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 oft San Joaquin Local Health District. r ` -----------------------------(Owner and/or Contractor) ----- ------- (Signed) s I -------------------------------------------------------------- (T�#(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). SPIRT N SE O i ATE - ----- -7--------------------- APPL1CATiON ACCEPTED BY ---- DATE-----------------------•-------------•---------------------- i. _. . _ . REVIEWED BY;"" ---- - ----. DATE--- "--------------------- ------------------------------ BUILDINGPERMIT SSU D ---------------------------------------------------------------------------- ---- Alterati ns nd/or r mendations:__ _"------- ------- -- ,r -IA--- _ _:_:Q:.----------------------------- _ __ _____ -____ --a " --•------------- -------- -- ------------- Date------------ - - --------- 1 FINAL INSPECTION BY:------ -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT no Wes+ Oak Street 132 Sycamore Street 814 North "C" Street 13o South American Street Trac California � Codi, California � Manteca, California Y. Stockton. California ES-9-2M Revised 1.57 F.P.CO.