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7 APPLICATION FOR SANITATION PERMIT Permit NCs77____a.1.. (Complete in Duplicate) Date Issued/__ _a�� Applical-ion is here/made 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 Ordin e No. 549. , }...... "' 7 ...-.----- --`-�- --�`--(— - - ---------------- •--•--------- . e _ eOwner's N --------- ---- (Ai*-4,JAddress -Sal( ----- 1t - ---- - -- ---------------- -- Contractors Name------------------------- ----------- ----•---=--- --------- ----------- ---�-•---•-0 � -�o6' M-�.-----•-•-------- F Installation will serve: Residence [��partment House ❑ Commercial Trailer Court ❑ Motel Other ❑ Number of living units: �_____ Number of bedrooms ._- Number of baths _/____ Lot size __________ ____11.6---.rA�,- ��___._.__ ` Water Supply: -Public system 91---Commuiiity system ❑ Private [Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑.; Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No © New Construction: Yes ❑ No TYPEOF INSTALLATION AND SPECIFICATIONS: 3 r y N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic-Tank: . Distance from neatest well Distance from foundation______1 -------Mate 'al No. of compartments .__Size.. Liquid depth ___Ca capacity ------ l - ------ - Di po al Field: Distance from nearest well---,?©__---.Distance from foundation_____ ______.Distance to nearest lot Number of lines___--__1.�__Y____ Length of each line________�?U- __________.Width of french_._.________---_-____ I Type of filter material_ ___ _ p g De th of filter niaterial________ `!___To#al length Seepage Pit: Distance to nearest well-----------------------_Distance from foundation---(----------------Distance to nearest lot line_____________ ❑ Number'of pits------------- -----Lining material=--_ -- ----- __'Size: Diameter ='"..... n___________.________________.. Cesspool: ,�. ,_ Distance from-nearest well!'--------------Distance from foundation.__-------------------Lining material--------------._----_----___________-- Size Diameters _ =-s _ _-._ De th_.___ __.________________ _____. _____ Liquid Capacity gals. Priv Distance.from nearest well Distance from n est-buiidin _ _ ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------= j Remodeling and/or repairing (describe):-, --- f-- -----�---- ------------•-------• ------------- ---------- r ' ------------------------------------------- x �.-...._ - ---------------------------'----------.------•----•---------------------- I hereby certify, that have prepared this application and hat therork will be done in accordance with San Joaquin,County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed)---- --------------------=----------------------------------- ----------------------------------------------- -- { I $y:.- .. .. 1 .._ -4 -------------------(TI tle)-------------------------------------------------------------- (Plot plan, showing sizdof lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). t . FOR.DEPARTMENT USE ONLY . ' APPLICATION ACCEPTED .BY----________________------ DATE-----------.Z.( - -- -- -_------------- ---•---------•--------------- ------ - IREVIEWED BY-------------------------------_ ------------------------------------------------------------ DATE------------------:---------- = ------------- BUILDING PERMIT ISSUED-=-------- ----------------------------------------------------------------------------------------- DATE----------------------------- -- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------.----------------•------------------ --------------------------------- - ---------- ----------------------•---••-•-------••-------•-- --- --- ---------------- V !. ..--- -- -•- --•--------- --•----- _. ... --------- ------------------------ - -- --------- � ------......� `--------- :---- ---------------------------------------------------- . c FINAL INSPECTION- BY:::_-:___r ---------- ------------------------ ----- ------------------------- SAN WXQ N LOCAL HEALTH-DISTRICT 130 Saufh. Ameriean Stre®# 300 lYes#�eki 5tree#_ .132 y amore Street 814 North "C" Street Stockton,4Californie , Lodi, California Manteca, California Tracy, California ES-9-2M Revised W^-2100