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APPLICATION FOR SANITATION PERMIT Permit No ..._ l_.. ---.. . # � w (Complete n'Duplicatel Date Issued Application is hereby made to the San'JoaquinitLocal Health District for This applicatioe permit to construct and install theworkherein described. n is made in compliance who n Or ante o. 549. r i.. . . _ 4 j} c e - /.' ,7 i Owner's Name - = r /. = / -•------------ --- ---------- ' CATION - ----- --- � � - --s .� _-• Add ress---------- .» v;r.. = Phone ' .i �y /z1 _______________________._ U + _________________________ _ ---------------- Contractor's Name ;------- ------------------- ------------------------ 3 ,. Phone-=------------ ---- Installation will serve: Residence' Apartment p nt 1-louse ❑ Commercial ❑ Trailer Court ❑ Model ❑ i O#her ❑ g - rooms --�._ Number of baths J-__ Lot size � 1 Water Supply: 'Public system" Commune+ s"'s ._�iQLI_ - ----- Number of liven units: of bed y system,[].❑ " 'Private ❑ Depth to Water-Table` Character of soil to adep+h of 3 feet:+ Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam_ ❑ Clay Adobe 1 ` y s Y ❑ , e [Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes No I ❑ ❑ FHA/VA: Yes ❑ -.,No ❑ , TYPE OF INSTALLATION SAND SPECIFICATIONS: .f - [ . (Na septic tank or cesspool permitted if public sewer. is available within 200 feet.), ee+} e�R ce from nearest wet____�____�_____ 4 1 ., Se tic Tank: Not of`Compartments___---_l - 4 Distance from foundation___________________Material__.__;-___' 'R "` ,� •t- --1 -----A Liquid Be th_,. --- ----- t Capacity.I.. F_" ,Y - _ - 't Disposa :e d: Disfance,from nearest well - ; t Distance from foundation__ _ _ Distance to nearest lot Ji 15 Number of liines___________ yl r "" - 1- Length of each line_-----,,7 Q----kf------Width of tre`chi'_.----•- �_ , Type of filter materi epth of filter material_---- --6. _.-__-Total length :_-_`- �_-- Seepage Pit: Distance`to nearest well ___ "" r Distence�from"foundation=__._:`.- Distance to nearestlof'i ne_ . ❑ Ivumbe� of pits:_--_ -- ---- Lining matenal_-- _--- •-' _ -- .Srze: Diameter----- •__--_r- r r" - Dep h t ------------------------------ Cesspool: Dis`arce from nearest well .*__.------Distance from foundation { ___ _________ _Linin 'material= ' g # t ❑ ` Size Diamei-ei'---------------- --- - ------•- --be th-'---- --- --•• --------- - -- --- - --- LiquiCapacity gals.d crom nearest well ------ :- __-__ ----------- nearest buildin _:h , - ❑ Distance to nearest lot line:-.'_`- --- '-°------- _-- � --- -- g Distance from -- ------- ----- modeling and/or repairing (describe) -, Re _ . ---------------- ---- ------- ----------- ------ - -- I4 - � � a J. _______ ________ -. ; - - ____ _ _ __ -------. _____________________..___.____ . ____-;-.____________________"_____ - . , - j----------- ------------------------ -------- ------------------------- - ! herebY certify l-have• "• _ _ re ared +his a PLica+ion�and�+hat the work will be done-in accordance with San Joaquin.Countyordinances Sfafelaws�and rules and re ulationsyof the San Joaquin Local Health-District.r A . (Signed - I - ____________________ _________ __________--------------------------------------- _ _ --------------(Owner and/or Con+rac+or) s --• g sIiz --------------------------'--------- -- ------ --- - ----- -- -- - {Ti+leI-------------- [Plot plan, showing size sof lot, location of system in.relation to wells, buildings; etc., can be placed on reverse_ side). FOR DEPARTMENT USE ONLY - - APPLICATION ACCEPTED BY --'-- - REVIEWED BY ---- DATE ' - ------ -- ------------------- -- DATE----- � BUILDING PERMIT ISSUED ---------------•------- ----------------------------- = --- Alte +ions and/or re ' mmend +ions:_..' -- - •-----•------------ - ------------- ��]✓ - •--------- . . �. �,, _ - - ----- - -- - - - -. FINAL INSPECTION ,gY:___ -------- - ._ -------_. - : � � -. '• .---= � .------- - - �... - Date_ . - ..J ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ Stockton, California814 North "c" street Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1-57 F.P.CO.