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L1 / ✓ APPLICATION FOR SANITATION PERMI Permit No. _x1!_ -24..� �i� (Complete in Duplicate) �f g Date Issued __/_ ��___ Joaquin cal Health District for permit to construct and install the work herein described. Appllcat�an Is hereby made to the San Joaq Lo This application is made in compliance with County Ordinance No. 549. 49 JOB ADDRESS AND LOC TION__-- �1 ►'+? ____s'"' ------------'�`A= �'U --- --------------------- - -------------------- -- Owner's Name ----------------------------- ----------- Address --------- n -- Phone Address----�-7 -------- -------- vvtz ------- --- -A--------------------------------------- ------ - ------- Contractor's Name-- -- --- ------------ ''.r c -- -- -- -- ---------------------------- ----------------- Phone-;/-6- Installation will serve: Residence Ap rtment House I] Commercial ❑ Trailer Court ❑ Motel E] Other Ottther Number of baths -_/---_ Lot size S ❑ Number of living units: _____ ._ Number of bedrooms=- -- __ _j`T� y l © , Water Supply: Public system ❑ Community system ❑ Private [)J_ Depth to Water Table 10 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe#Q Hardpan ❑ Previous Application Made: Yes ❑ No JQ New Construction: Yes Uk, No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4 I Septic Tank: Distance from nearest welL..$..V..---_-----Distance from foundation-IV---_--______.Material-------------- ---— -I,/--------- 7w`�-----_--- No. of compartments----2..----- ----------size--- -------Liquid de th___ .__`__ ._:__ Capacity-9-0 Disposal Field: Distance from nearest weil_!_s..�.�.._.....Distance from foundation--AO--_-_.-.'.Distance to nearest lot line_- ------------- Number of lines_._......._--_ ---._--- Length.of each line-----7- Width of trench_____ __�1'�- _ --------- � � Type of filter material____'&' -----.Depth cf-filter material-.l�'_._-----__-__Total length--}--,/ice'--------------------------- h: Distance to nearest -Distarrce fromoundation---'�o-_-_--___-Distan e,to nearest lot line--%! -------- Number of pits----�_.---._ .t Rnarterial-�'- --------Size: Diameter--IV _ _.__._.Depth ----------------------- Cesspool: ___________________Cesspool: Distance from nearest well-------_-__-_____Distance from foundation- -------------_-_.Lining material--.--__-____-----._-----------_------ Size: Diameter----------------- Depth-i,_--- ___.__---------LiquidCapacity Ca acit -___-__-__----_gals. Privy: Distance from nearest well-----r------------- '------------------Distance from nearest building } I ❑ Distance to nearest lot line -- ---- --:-.----�------ ------ --------------�----------------------------------- -- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------i--------------------------------------- ---------------------•----------------------------------------------------------------- ------------------------------------------------------ ------- --------------------�--------- ----------------------•---------------- ----------------------------------------------------------------------------------------------------------------------------------------- !ti` i I hereby certify that I have prepared this application and that A work will be dbne in accordance with San Joaquin County I ordinances, State laws and rules d regulations of San aquin cal Health District. } (Signed)-------- - -------- _ ------------- --- = {Owner and/or Contractor] -. BY.. r ----- ------- {Title) (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). T FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY------ -- ------------------------------------------------------------------- DATE---------- ---------------------- ----- --------------- REVIEWED BY-------------------{----------- ----------------- --------------- --------------------------------. . DATE----------------------------- ------- --------------- - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------- ---------------------------------- Alterations and/or recommendations----- - -------------------------------------------------------------------------------•--------`------------•--------------------------- ---------------------------------------------------------------------------------------------------- ----------------------------------------•-------------------------------------------------------------------------------- --------------------------------------------------------- ---------------------------------------------------•------------------------------------ -------------------------------------------------------------------------- ------------------------------------------ --------------- ----------- = -------- FINAL INSPECTION BY:----------------_------_ Date------------------ -----5- - - - ---------------- -7--------------------------- SAN JOAQUIN 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 i E5-9-2M Revised 3-57 F.P.00.