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• APPLICATION FOR SANITATION PERMIT Permit No. --- ---- !� t (Complete in Duplicate) Date Issued ---- / Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------1- 1-3------------4-v-j1 TOwner's Name Ew_ _�5� ---------------------------• - ------------------.--.--.------Phone--I--- ---------------- Address -------------------------------------------------------+---------------------------------------------------------._...---------....--------------------------------------------------- Contractor's Name ------------- °------- a, ...w ;-C�_..-i: * ' '---------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: ^_ Number of bedroom _� Number of baths !!� Lot size ---------IQ--X-.__M CI_______-______________ Water Supply: Public system 2''Community system Private ❑ Depth to Water Table 35' ft. Character of soil to a depth of 3 feet: Sand ❑ Grav ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ {adobeHardpan Previous Application Made: Yes E] No V New Corft+me ioi---Yes --No-B- /�.-Yes o-.-.--No El ❑ ❑ TYPE OF INSTALLATION AND SPEC[FICAITIONS: E (No septic tank or'cesspool permitted'if public sewer is available within 200 feet.) r Septic k: Distance from nearest well Afaro1Et`I4 o ridation t `_ ..Ma er�al-- �4 £�' }�--------------- merits -- -------- No. of compartments____s. '____Size 4 �_9_x__--�--____..Liquid depth__.._'--------------4Capacity_f ___--_- I Disposal Id: Distance from nearest well K0N.4;-Distance from foundation Distance to .� earest lot lin2:_... 7... Number of lines........3_11 _____ _____Length of each line_SQ $' � __5�.Width of trf--- --------- nch-----�_'�,___________________ Type of filter mate ria lliff n_$fpepth of filter material--j --- lengthAQ________________ Seepage Pit: Distance to nearest well __________Distance from foundation.............` [..Distance to dearest lot line__________-_ ❑ Number of pits____ _____ Lining material-----------------------Size: Diameter------------------------l3epth -___-__________-_______- Cesspool: Distance from nearest w(ell-----------------Distance from foundation-------------------- Lining mateiial-------------------------------------- El ___ _____ __________ __________❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Captity----------------------------gals. Privy: Distance from nearest well-----------------------------------.___ _____pisfance from n arest,,,�U�lding{----_------------------------------------- Distance _ ______________________________Distance to nearest lot line__ ,_ ;,: .------------ ----------------------- Remodeling _----Remodeling and/or repairing (describe)----- r- ------ ----- --------------- -------- --------- ------ --------------------------------------- -------------------------------------------------------------------------- - -------- --------------------------------------- ------------ ------------------------- - ------------------------------ ----- -------------- -------------- ------------------- ------- --------------------------------------- I hereby certify that I have prepared this applicatic "�rid-i+t�e+-Nve-wor t dobe in accordance with San Joaquin County ordinances, State laws, nd rules and regula ions pf the San Joaquin Local Health District. (Signed)_ --------_:---(Owner and/or Contractor) --------l----- By:---------------------------------------•- -- ---------- ---------------------------------------------------(Title)------------------------- ------------ ------------------------------------- (Plot plan, showing size of lot, location of system in relatnto wells, buildings, etc., can be placed on reverie side). FOR MENT USE ONLY qr APPLICATION ACCEPTED BY-------- ---------------- DATE---4-- . REVIEWEDBY--------- ----- -- -- --------- -- ----------------------------------------------- DATE--------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------- -------------- DATE------------------------------------------------------------- Alterations and/or recommendations:..__._- -------- __ _ _ _ . • j -l------!----------------------------------------------------------------------------------------------------------- --------------------------------------------- ---------------------------------- --------- ------ ------ ---------------------- -- ----- ---- ------ LL FINAL fNSPE Date-------- r ----------- --------------------------- 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 1 ES-9-2M Revisea 1.57 FRCO.