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�1� APPLICATION FOR SANITATION PERMIT Permit No. -- - _ _l-__-- A (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 Ordinan e No. 549 JOB ADDRESS AND hQCAT40N I - ------------------------ - --------l---------------------- Owner's Name ----------- -I---------------- -------------- ------------------------------------- ------ rn°ne- f -��- ---------- iAddress-------------------••-------------••----- `---•7•-----�• --- -��-------------------------------------------------------------------------------- Contractor's Name----------------------- ---------�- 0_10_ie�---------- [ �---------------------------- Phone-- kJ Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedroom ____ Number of baths'/------ Lot size .....�j�_ f(� Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Tablee4lft. Character of soil to a depth of 3 f�VNo and ❑ ravel ❑ Sandy Loam ❑ lay Loam ❑ Clay ❑ e ardpan 0 Previous Application Made: Yes New Construction: Yes No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) a 1 Septic T Distance from nearest weII -------Distance from foundation---/,0-------- Mater�l__C�-8�"(-G-.r`�-----------. No. of compartments-----�-------- ----Size- � ---Liquid � �------Capacity..--e �------ } Dispo4 eId: Distance from nearest well_--/-,.Distance from foundation--�D__i...--.Distance to nearest lot linetif --__- . Number of lines-----------------------------------Length of each line------------------------------Width of trench*_1__r2-------------------------- Type ----------------------- T e of filter material .______De th of filter material__-le-__'---._ Yp p - � ---Total length----��-�--------- ----------- I i-----See V Number of pits------Z------------Lining material----Y'44. _._.Size: Diameter_--.�------ Dept h----4�:._-__------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------_____________._---_--_________ ❑ Size: Diameter--------------------------------------De th---------------------------_ --- --- .-Liquid Capacify-. gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe) r � `j� -- --------- - -- ------ =r 'r -------------------------- 9[ ---=-----------------------------------------------------------------------------------------------------•---•---•-------------------------•----------------- ----------- ---------------------------------- ----------------------- •--------------------- t 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 regul ' ns of the San Jo Local Health Dis r (Signed) lQ/�/�---- --------------------- -------------------1------------------ -------- -----(Owner and/or Contractor) I By: �'� F - -----------------------(Title)-- =G� -------------------- (Plot plan, showing of lot, ocation of system in-relation to we s, i rags, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ... Y w APPLICAT10iV ACCEPTED BY = DAT1W Gi n R - - --- ------------------ REVIEWED BY '= --------------- = ------------ DATE---._'_ _.---------------- .. BUILDING PERMIT ISSUED-----------' - - DATE Alterations and/or recommendations: --------------------- ------- ------`---------- ------------------_----------------------------------------•-----------•--------------------------- 1 ---------------------------- ----------------------------------------------------------------------------------------------------------•---I---------------------------------------•--------------------------- ., .............•-----------------------•--------- - ----- I FINAL INSPEC BY: D to------ "` � -- -- - ------ SAN JOAQUIN\LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street', Y' � �, „132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO.