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APPLICATION FOR SANITATION PERMIT Permit No. ......7 (Complete in Duplicate) Date Issued ---- 14 A bed This is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri . 's application is made in compliance with County Ordinance No. 549.JOB ADDRESS AND L ATIO --------------------------- Owne'r's Name------------ ------------------------------------- Phone F Address-------------------------- --------------------------- _ ----- ------------------------- pl� m_ Contractor's Name ------------ ------------ - - ------_--------------- ------- -------------------------- -------------- Installation will serve- Z Residence D4 Apartment House Ej Commercial E] Trailer Court E] Motel 0 Other El Number of living uhits: Number of bedroomsNumber of baths j---- Lot size I -- -_ . -_ --------------------------- Water Supply: Public s y-S't e m' Community system [:] Private E] Depth to Water Tabls.5_j0_ ft. Character of soil to a "th ;f 3 feet: Sand Fj Gravel Ej P Sandy Loam E]. Clay Loam ❑ Clay El AclobeX Hardpan E] Previous Application Made. Yes E] No 5T_ New Construction: Yes El NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank':o'r cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_---------------Distance from foundation--------------------Material EIUIS' Nc of compartments-------- ------------ ----Size----------------------------_Liquicl depth--------------------------Ca pacity----------- ------------ Disposal Field: Nfance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.---__----_..__. E1AX1SVNt5:' Number of,lines___._ -------------------------------Length of each line------------------- -----Width of fren"ch Type of filter material-----------------_-------Depth of filter material--------------- --------Total length__-.-----_---.___ ----------------- Seepa ength------------------Seepa e Pit: Distance fo'.ne;res-t well,47.0tA Distance m foundation....... Distance to Number of%P' ifs_A� --- D I Lining material_--44C� OK_Size: Diameter_.13 Cesspool: Distance from near(-esf well-----------------Distance from foundation-- -- --------'_ _Lining material----______-__.-___.----_--__-__ ❑ Size: Dia aterial--------------------------------- Size: Dia nefer-------------------------------------Depth-------------------------------------------------..-Liquid Capacity_- ------------------------gals. Qj Privy: Distance from nearest we"---- -----------------------------------------Distance from nearest building-------------------- r 'Distance �o noaresf lot line-- -------------------- ----------------------------------------------------1-1--------------------:------------------------------------------------- Remodeling and/or. repairing,(describe):------ ...... .... ....... ------------------------------------- -------------------------71l------------------------I------------ ------ - ------------ ------------- -------------------I-------------------- ---- • ---------------------- -------------------- --------------7-------------------I-------------------- I . - - --------------------------- ------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------- ------------------------- -----•-•------•--•----------•- -----------------------......--------- I hereby certify that 1, hn - ed this application and that the work will be done in accordance with San Joaquin County V-'I� u r ordinances, State laws." a rules and re fions of e San Joaquin Local Health District. ........... . (Signed)--------------------- -- ---------.. ..... . ----------------- - ------------A-Owner and/or Contractor) By:----------------_- - --------- ifie)-------- --f-------------- (Ti ----------------- ion o system in relation to (Plot plan, showing s4 46f tlo:�Iocafl*"n TyZfrn/. wells, buildings, etc., can be place on reverse side). C; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--•------------------ REVIEWED BY------------------------------ ------- ------------------------------------- DATE.. -------------.... ...................................... BUILDING PERMIT ISSUED: -------- Alterations and/or recommendations____ ------ -- ------------------------------------------------ •DATE------------------- ------------------------------ ---------- 10- . --------------------------------------------w-----------------1------ ---------------------- ------------- ------- --------- --------- ---—------------------------------------------------------------------------------------------------- ------------ - ------ ---------------------------------------------------------------------------------------- -- ------------ ------3--------------- -------------------_---------- ------'--`-----•------------" i: ------ ------------------------------- _.j--------------- -----------------1------------- ------------------------------------------------------- _._•-------------------- --------------------------------- - _ FINAL INSPECTION-BY:... Ez„ --------------- ----------------------------------- ---------------------- ---------------- ------ ------------- ---------------- 1 Date-= _/-—---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street - 300 West Oak Street 132 Sycamore Street 1114 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100