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('�'� 10 APPt CATr0N FOR SANITATION PERMIT Permit No. __1.� /3 z-- l a {Complete in Duplicate) i Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to This 1 application is made in compliance with County Ordinance No. 549. construct and install the work herein described. JOB ADDRESS AND LOCATION_" iO .J �__.. , .. --- -------------------------------------------------•------- ------------------------------------ - Owner's Name_ ___- ' - ------------------- -------------------------- ------------- Phone------------------------------------ ------- Address--------- -- -------•------------------ ��-----•---------------------- Contractor's Name----------- _ : , ,, , "" --------------------------- - ❑ _ _ ' ---------- -------- - --- --- ------- - - --------------- Phone------------------------------ --- % Installation will serve: Residence p ❑ 11 ®�A artment Mouse ommercial; ., Trailer Court ❑ Motel ❑ Other ❑ Y 0 Number of living units: ___/--- Number of bedrooms _ Number of "aths="�_ Lot size " Water Supply: Public system ► �--------------------- Community system ❑ Private E] Depth to Water Table _19--. ft. C Character of soil to a depth of 3 feet: Sand ❑ Gravel n—Sandy'Lcamlfl—Clay Loam ❑ Clay ❑ Adobe E,� Previous Application Made: Yes No rlardpan ❑ ❑ � New Construction: Y ❑ No�! FI-IA/VA: es [] No �� f TYPE OF INSTALLATION AND SPECIFICATIONS: '. ! {No septic tank or'cesspool permitted if public sewer) I is available within 200 fee+. I } ptic nk: Distance from nearest well_________________Distance from foundation------------------- No. �� Material of compartments -------------------Size--------------------------------Liquid depth-- -- +'' - v -------- jCapacity ispo �F lId: Distance from nearest well_&-_q_L;pistance from foundation.._�Q Distance to nearest lot line__ ______ • -Number of lines____-_______r_-_"_-_______ _ Length of each line------___ _ � t:�° s/ Width of trench ,�• Type of filter material_" __ s� `y----------------Depth of filter maternal__/e-"" ---------Taal length_. ______f Seepage it: Distance to nearest well-___-.`r'-"""___Distance f m f ndation_"� _ Dista F e to nearest lot line- It Number of pits-__: __________-Lining material__ Size: Diameter--- ------------ .Dept h_-- -94 --.- - Cesspool: Distance from nearest well-----------------Distance from foundation------------------►Lining material--..__-- --- ------------------------- Size: Diameter------- --------- ---------- -------Depth------ ---------- --- ------- --------------------� --- Priv Liquid Capacity--- Y: Distance from nearest well__________--------------------------------------Distance from nearest building ❑ Distance to nearest lot line____ ______ ____" _----_ _ _ ] } ---------------------------------- ------- ----------------- -------•--•------------- -- ----------- Remodeling and/or repairing (describe)------------------ - - --- ---------- ----------------••-------------• --------------------------------------------------- ------- -----------------•------ ------------------------------------------------- i - -------------------------------------- -- -----------------------------•-------------------- ordinances State laws a rule p - -pp -------------------------------------------------- - --------------------------- -------------- ----------- --------------------------- --------------- I hereby certify the+ ! have pre ared this a lication and that +he work will be done in accordance with San Joaquin County s and regulations of the San',Joaquin Local Health District. (Signed)--- - -------- -- -- --- -- ------------------( Contractor) By:_ -----------•------------- (Title,)..... --- (Plot plan, showing size of lot, locoon of system in.rely+iono wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ __________________ DATE_ ------------------------------------------------------------- I - DATE--- BUILDING PERMIT ISSUED---- I Alterations and/or re me dati ns - - ATE--- ---��------------------------------ ------------------ ------------------ Q�_c = ``� . of= ----------------------- - -- ------- - --------------- --------------------------------------------------- ---------- I l -- ---------------------- ------------------ FINAL INSPECTION BY:.-----"- -_ __ ---_-- -yV--- ----------•^---------------- f Date ' _S�� - - SAN JOAQ�U,IN LOCAL'"HEALTH DISTRICT 130 South American Street 300 West Oa• f eet '� F32 Sycamore Sfree k 814 North '•C•' Street Stockton, California Lodi, California Manteca, dalifornia Tracy. California ES-9-2M Revised 1.57 F.RCO.