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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) y/ Date Issued Application is hereby made to the This application is maSan Joaquin Local Health District for a permi��str��and install he worts heredescr'bed. de in compliance with County Ordinance No. 549. in-- 1 i JOB ADDRESS AN4LDCATION D - - ,•. - _- td� P Z. Owner's Nam - 7{{4��/ 1 a --- ---- Phone. Address a a!_ �-- - == = -------------- Contractor's Name--- - -- -- ---- --------------- --------- •-- - ------------------------------------•------------------------------- Phone-----•--•---------•---------------- .r Installation will serve: Residence [9 Apartment House ❑ Commercial ❑ Trail r r Court ❑ .Motel ❑ Other ❑ Number of living units: _-t1.--_ Number of bedrooms4-_-- Number o aths f A' . g bt.-•- Lot size --.1� x � �------------------- _ --------------- Water SupplyPublic system ❑ ' Commuriit�i'system ❑""Private Depth"to'WaterTai5l6'7t !.ft7-+" ,- Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy Loa' ❑ ClayLoam 44 Previous Application Made: Yes ❑ No ❑, New Construction: Yes No , 'Clay [� Adobe ❑ Hardpan ❑ I ❑ ❑ FHA/VA: Yes 0 No-K, i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitfed if bid sewer is available within 200 feet.)f � Septic 'ank: Distance frorri'riearest-wel � 11 �ry .-.- istance from,foun cation_-0. `+��` lJ- Materi No, of compartments-----------A<l.-- 1 i _Y_ istance/0'!6�' Liquid apt ------ --- ___----Capacity_____ I S]],ze-_----�x _ Dispos I Field: Distance from nearest--well. l7 �"[}' r f! oundation-�SJ _ '��istance to nearest lot line _-.c�� Number of lines---- --- ---- i - y�" Length of each line-------------` o -=--- Width of trench_-----.-- ,r- r� - -T Type of fit#er materiel _ A p &-j--Tofal -1-------------- r e th of filter material-------_ length-------•---•-_-=: e ------_-.;,,, w.Seep Pit: Distanceto nearest ell__--�-0---- Distance �r —m`.foundation � --� �stanc to nearest lot line- j Number of pits-------- ----- -----Lining material--_ ...,� - ' "I Size Diameter----`Z4--------.Depth _ cti i Cesspool: Distance from nearest well-_---_--_--_..'Distance from foundation_El __"_': ^-"Lining material---Diameter Depth --------------.-_----f Li uid'Ca aci • q p tY----------- ----------------gals. Privy: Distance from nearest well _._----_-.--_-_ ------____---------=------Distance from nearest building � El Distance to nearest lot line---._--- ---------------------- - --_.-__--_ - - g -----------•-------------- - ---- -- ----------------------�--------------_----------------------- Reemodelifig and/or repai(ing (describe):_----_--__ r' 4------- - ` fir.- �^t4�'_� 7L. - ------ — ,� -- a. --------- -- - ---- - --------------------- =-------------------------------------------------------------------------------------- ---------•------------`----------------------------------- llereb certif + t I have p pp ------ ------ Y Y prepared this a lift+ion and that the work will be done in accordance with`San Joaquin County ordinances, State laws, and rules and regulations of the S n Joaquin Local Health District. (Signed)--------- x '-u�- 1�2 ® .6 - - A ----- ---------------------------------------------------------------(Owner and/or Contractor) By:. --------------- = --------•------•----------•---------------------(Title)------------------- --- - (Pl of plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY DATE!��_-- REVIEWED BY -. �------------------------------- ------ ---------= -------------- DATE-_r BUILDING PERMIT ISSUED-------_�- - ----------------------- Alterations and/or recommendations:-------_:_._ •-------------------- ----------- ------------------•---------- -------"---------- ---- ---•-------------------------------------------------- .FINAL 1NSPECTION BY: _. .� D _ - --------------------- ----�.----- ate--------- ------•---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast 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.