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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate);Zj �// -r 1 Date Issued -----___/_7/_1____! Application is hereby ma�i� ie an L- aI Hee d'ct for a permit to construct and install the work herein described. This application is made n ompliance with County Oridindnce No. 549 JOB ADDRESS AND LOC ATIO -_6-��.°Z_________________._,�_, ,�,8 l- -----�414--------------------------------------------------------------•----------------------- Owner's Name �'�` __ Phone----------------------------------- Address-----------------------------------------------•----------•------------------------------------------------------------------------ $� J4& - -----------------------•--------------- Contractor's Name---- � "_------•--------------•------------------------------------------------------------------------- Phone----_---------------------------- 6Z Installation will serve: Residence ❑ Apartment House ❑ Commercial ® Trailer Court ❑ Motel ❑ Other ❑ �: Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size hC_/_S` -------------____--"-_-_--_--_-_ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table 14--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe If Hardpan ❑ Previous Application Made: Yes Pk,. No ❑ New Construction: Yes 4 No ❑ FHA/VA: Yes ❑ Noip TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest weld: -Distance from foundation-_P---__.-____.Material--_- e i -- No. of compartments-------2�-------------Size___. dZ__dXs`'____.---Liquid depth------!9-'_-------------Capacity..... s � '. Disposal Field: Distance from nearest well___7_---------Distance from foundation__!�------------Distance to nearest lot line---- -`-:J--- ® Number of lines-------I--------------------------Length of each line-__-__4i_'�!;'_-----------------Width oftrench--Zk'----_.__..______-__-__--_ Type of filter material-_-T_4_�----------Depth of filter material---lr y._.____..Total length-------4:Q__`______________.______-__ 34F4 Se it: Distance to nearest well----- __Distance from foundation_4.6...........Distance to nearest lot line__$"'.__...__ ix Number of pits_,________________Lining material-_--7?4<1f______Size: Diameter___"- ---------Depth---------10:7------.-_._____._- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------______-___-. ❑ Size: Diameter-------- -- ------Depth---------------------------------------------------Liquid Capacity--------------------•------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-.________-____.-_____.__-__-...__._--______ Remodeling and/or repairing (describe)----------------- ----- --- --------------------------------------------------------- ------------------------- --------------------------------------------:--------------------------------------------------------------------------------------•--------------------------------------------•---•---------------------•------------------ ------------------•-------------------------------------- _________________________________________________________________________________________________ -'y ____"__________________________________________________________________________________________________________._________-________-____-_-____-_____-_-_______-_-_________-_•---__-__--•__--__-_-__.__..5--_-__-------____.._____ I hereby certify that I have prepared this application and that the work will be done in accordance with San JAaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ✓ AA(Signed)-------------------------------- _______ _-__.____.---(Owner and/or Contractor) ------------------- ------------- By:------------------• =�{? -----------------------------------------------------------...(Title)---------------------------------------------------------------- (Plot plan, showing size of lot,ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ----- -- --------- ----- -------------------- -. DATE----------- 4�------------------------------ REVIEWEDBY----------------------------------------------------- -- -------------------------------------------------- -------- DATE----------- ----------------- BUILDINGPERMIT ISSUED------------------------------ ------------------------------------------ DATE------------------- ------------------------------------- Alterationsand/or 7ecoendafions:---------------------------------------------------------------------- ------------------------------------------------------------------------------------- -------------------------------- = __._Q L.- - ----------. . ---------------------------------------•----------------------------------r = - ---------------------- ------ ------------------------------ -- -------- - _i..� ---- --s. '"Q�f �c�� c. -_,' �'i ----------------- /z,- -------- - FINAL INSPEC . ------- S JOA .LOAL EALTH 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 1.57 F.P.CoNc / e,