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APPLICATION FOR SANITATION PERMIT Permit No . 7 (Complete in Duplicate) - �, Date Issued This application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ation is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION--------- Owner's Name----- --------- t _ -------------------------•----------------------------------•----- ----------- = - ---------------- ------- --------------- ------------- - Address__ ------------------------- Phone----------------------------------- .------------------------------------------------------------- --•- Gontractor's Name"""""._"_.__"--_".""""-.- _ ---- - f`� ._. Phone- --------------------- Installation will serve: Residence " --- ------------- partment House ❑ Commercial ❑ Trailer Court ❑ Mofel Number of living units: . ""_,�._ �f E] Other ❑ Number of bedrooms """"_""" Number of baths _ Lot size "_ � XX/ S' Water Supply: Public system Y• y ❑/Community system ❑ Private ❑ Depth to Water Table "l-/4 ft. Character of soil to a depth of 3 feet.- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe and an Previous Application Made: Yes ❑ Noy[ �- p E]� New Consfruction: Yes 0�� ❑ � I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �&j is T -. - Dr sfance from nearest well-----------------Distance from foundation------__-" - 0 No. of compartments-------------------------Size----------------------- Liquid dept------- th__. --- -- ', ------- - - -Capacity----------------------- osal F' : „ Distance from nearest wei ------"---__-Distance from foundation--------------------Distance to nearest lot line""_-""_"""""."",- Number of lines-----------------------------------Length of each line------------------------------Width of french Type of filter material--------------------------Depth of filter material-_.--- .. Total length ---------------------------------- Seepage Pit:- Distance to nearest well- Y� Distance from foundation �d- Distance to nearest lot line--_'5------,- Number of pits__--" ._"""" "_"Linin material"""S! c' �}J 4µ g �•tA�06Size. Diameter----• -�-- ------.De to Cesspool: Distance from nearest well-----------------Distance from foundation.:------------__ .Lining material"_"" N❑ .Size: Diameter----- ---------- --------- ----- Depth-------------------- ----- ----------- ------ - - -----Liquid Capacity- ---------- --------- ----gals. 6 Distance to nearest lot line__-" � Privy: Distance from nearest vrell"-_.""""___...".__""""._--"""_"-."._____-."__"""._Distance from nearest building ------- -----.-_ -------------------------- Remodelingand/or repairing (describe):-_----------------------------------------------------------------------------------------------------------------------------------- ---------- ------------------------------------------------------------------------------------------------------------------------ -------------------- ----------------------------------------"----------•-------"------------------------------"--------------------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laws, and rules and regulations of the San Joaquin Local Health District. ,I ! � -------�----------- ------------------------------------------------ /7_( weer and/or Contractor] (Signed) A J/ O y� ------------ ---------- // gY=----------------------•---,�� -4 �==--- -r,�irk,-✓" ----------------------------------(Title) ---- ------�-- -a ------------------- .{Plot plan, showing size of lot, location of system in o;ation to wells, buildings, etc.; can be pla ed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -------------------------------------------- DATE------ REViEWED BY --------------------------------------- ------ DATE �- ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------- ------------------------ ------- --------------------- DATE Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ---------------------------------------• -----•--------•---------------------- ----------------------------------------------•----•-•---------------------------------------------------------------------------------------- � fes/ FINAL INSPECTION BY-------- ----------v ...._. Date.-----------/-" 1 ------------ 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 ES-9-2M Revised W-2100