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APPLICATION FOR S ANITATION PERMIT Permit No. +u any 1 , (Complete in Duplicate) 11 Date issued Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N . 549. JOB ADDRESS AND LOCATION_ 10-4_ ___-- 1 --- , Owner's Name ----------------------- Phone-_� fAddress------------••------------------------------------ Contractor's - .tf(.: � - .. - : -& �_ S ------------------------------------------------------------ Contractor's Name ` ' '' ... � _ -7/ IC, Phone__ - ' l �ZV Installation will serve: Resid ce bt Apar+ment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: J-__ Number of bedrooms _Z_ Number of baths .-/___ Lot sizeX. _ Water Supply: Public system ❑ Community system ❑ Private X Depth to Wafer Table _ f . Character of sail to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe-X Hardpan ❑ '` Previous Application Made: Yes ❑ No;K New Construction: YesV No ❑ Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-^''--1�-� J Distance from foundation______ ______"_Malarial_t � !i„I�c it .1, ( �. F No. of compartments____________ __ J , Size- __ iquid de th = + F -epacitY-C C7 . Disposal Field: Distance from nearest well_ __� Distance from foundation-_�� ...Distance to nearest lot line- a [� Number of lines___�- _ � -�� ------------- Length of each line---- --- trench of filfier materia____�_ ---_ _-_Total len th-_, _ g - -------------------•----- 19 Seepa e Pit: Distance to nearest well_- - /00_" Distance fro f,-o�ndation__//a ____.Dista c to nearest lot line_ �___-I Number of pits---____r/.-________Lining material_ l----Size: Diameter-___c �_ ' -----,Depth_-- --�--�------------- Cesspool: Distance from nearest well_______________"_Distance from foundation-------------------- material____-_-_---_-__________________ ---- ❑ Size; Diameter - --------------------------------Depfh_--- ---------------------- -- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_____________ ❑ Distance to nearest lot Distance from nearest building ------ ------------------------------linex ----------------------------- ---------------------- Remodeling and/or repairing (describe):___"___"__________ --------------------••----•-------------•------------------- -------•---•--------------------- -------------- --- --------- --------- -- ------------------- -----------------------------------------------------------•-----------------------------•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances 5a laws; and r6l ands regulations o San Joaquin Local Health District. (Signed) , � 1 - ------------- --- (Owner and/or Contracfvr)• By:-------- r -- ---------------------------------------- --(Title) _dCi74 {Plat plan, shy ing size of lot, Iota+ior► of s em in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______ __ -, - - -------------------------------------------- DATE--.--- ----------- REVIEWED BY---------------------------- # 7 -r DATE BUILDING PERMIT ISSUED-------------/----- -------------------------------------- 55UED____----------------- �--- ---��="=-•-------- """` ------------------------------------- ----------------------- --------------------- DATE Alterations and/or recommendations:__-__._ -------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL ------ - ------------------- FINAL INSPECTION BY:------- ` { _- ]� -�s Date ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D Wes} Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M a-51 .Revised W-2100