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Permit No. _. 1 -----•---- APPLICATION FOR SANITATION PERMIT `/` (Complete in Duplicate) -Date Issued --/(-l :..+ l i p,pplica#ion is hereby made to the San With Countca0 denatnceDlNoC549 a permit to construct and install the work herein described. This a , Lica#.iori=is=x�ade in compliance Y --o Iry 'JOB ADDRESS ANS CATIO P ------------------------------------ --------------------- hone----.-_---•-------------- !Owner's Name"--- . ---- . -., - {,. - ------ ' - --•---- - --- -------------_--------•----------------------------------- -•---•---•-•--.. Address---- °� r ---- one .-= Contractors Name-_.---.- �R j Other Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ i Number of living units: _�_._ Number of bedroom Number of baths --�" Lot size - r`' Water Supply: Public system ❑ Community 'system Private ❑ Depth to Water Table .�t� Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe[1-�Mardpan ❑ Character of soil to a`depth of 3 feet: Sand ❑ ❑ Y I Previous Application Made: Yes ❑ No nl�rNew Construction: Yes o ❑ F.HA/VA: Yes 9l�lo 11A' 1 TYPE OF INSTALLATION'jND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) +� 4. _ �� Mateal - - - Septic Tank: Distance from nearest well-`-----' from foundation-- `� -Ca acit -• ,� 5ize_x x a----Liquid depth T P Y No. of compartments--_ a 4 f- Disposal Field: Distance from nearer, well_7"7'------Distance from fou n atio�.---. -- �istance to nearest lot linl�--------------✓"" �( Len th of each Iii ne--__ - ---Width of trench -" - ----------- ®.�'" Number of lines -`--- - --- --- -------------- Length Total length --- Type of filter material _ _. ---_-__--Depth of filter material � g .01 � .._ ...��, �' Distance to nearest lomat line_`e--`--- Seepa t: Distance to'nearest wel =_--____-- 4_" Distance from foun tion---' ......... �ize: Diameters - ------------Depth-----A�----------------- Number of pits---"- -------------fining material-- .: li - 1 I Cesspool: Distance from nearest well-----------------Distance from foundation--------_'.'_----_.Lining material_-.___"-..--_-._--"---_----^- --_"_. -_--De th-------------- ----------------------------------Liquid Capacity gals. ❑ Size: Diameter----- "-- ------------ p Distance from nearest well---.--__-. .-"-__- _ Distance from nearest building----'----------------------------------- - Privy: ❑ Distance to,nearest lot line----r---- --------------------- ----------- -••----------------- i ' ; --------------------------------------------------•- �� Remodeling and/or repairing {describe :--_ - , - ------------------------------- --------------------------------------------------------------•-------------- ------ -------------- -----------=------------------------•------------- •------------ 1i ------------------------- 3 .. . L :, - - Ok ---- I I hereby certify that I have,prepared this application and that the work will be done in accordance with San Joaquin oun y ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. I Si =-----------------=--- -- (AweeF; a d 1^z-,C ontractor) (Signed) ------ --------------------------- s f [Plot plan, showing siz f lot, location of system in relation to wells, buildings, etc., can be placed on reverse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------------------------ - DATE ` - ---------- DATE- -------- ---------------------------- REVIEWEDBY------------ •-------------- ----- = --- ---- `-------- DATE--------- -------------...----- : i BUILDING PERMIT ISSUED------------------------------ ------------------------- --- i i Alterations and/or recommendations:----------------------------- ------ -- ` --------------------- `�� I _ - _ � .. ------------------ I : ----- --------------- I -------------------------- -------------------------------------------------- ' ------------------------------------- SAN ---� --------'� Date---- ��"--�---�--=- --- --- -- -----------"------------------- -- � ' FINAL INSPECTION•�BY:_-�:-.-�.•.�.)_..�,----== --------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT I H14 rlar+h "C" Street 300 West Oak Street 132 Sycamore Street - ; 130 South American Street Trac California Stock+on, California Lodi, California, '�- Manteca. California , Y� ES-9-2M , Revise* 1.57 F.P.CO.