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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) G / Date Issued VAp lication 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 Ordinance No. 549. JOB ADDRESS AND LOCATION.-- _,::,1- ---------------------------------=-------------------------------------------------••---- - cc,, Owner's Name-------- t -- = Phon ..s�'`J __. Address------------10,t' '?'f:---- ---------" --•----••---------------•- - Cantractor's Name " �"= -�---- --'----------------------------------------------- -- Phone.---___--•-•------------------- ' 1 a [� p o mercial ❑►' Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence A artment House Number of living units: __.L_ Number of be Nsarr;ber of bat s __L.-. Lot size P _ ___.f"______�_______._.._.__..__._... Water Supply: Public system '0--Community system ❑ Private ❑ Depth to Water Table -------- ft: Character of soil to a depth of 3 feet: Sand . Gravel E] 'Sandy Loam El Clay Loam ❑ Clay E] Adobe ardpan El Previous Application Made: Yes E] No New Construction: Yes E] No ❑ FHA/VA: Yes E] No El 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public ewer is available within 200 feet.) / _ / Septic Ta Distance from n nearest well__ _Distant from oundation .____.Material_T_--^— �j --- ---------- - No.'of tom artments___ Size_A]_£z�� _____.�'_.___Li uid de th__. j_"________Ca acit _ D____.__.. p '1.�------------- ` G p p Y--- �L 4b h Disposal Field: Distance from nearest well_F�'�____Distance rom foundation_ __ Distance to nearest lot ,ne_._ ...... Number of lines____________________�_ -f__ Length of each line_am -__'pp Width of trench_______ Type of filter materia - bl Depth of filter material__.___tII__��_____Total Seepage Pit: Distance to nearesf'weII140--------Distance jvrn foundation_____-_---_•--------Distance to nearest lot line`___ ___ Number of pits'--- ---------------- g � // p Linin material__ ..:7' _______Size: Diameter__ De th__.a♦47_______________. r Cesspool: Distance from nearest wel!____--_-_--_ Distance frooundation------------------- Lining material----- ----------- - ----- ----------- 0 (� , Size: Diameter------------------------ ---.De th--------------------- -----...---------------------Liquid Capacity gals. Privy: Distance from nearest well_______________ ----------------------D.istance from nearest building-------.------.__ ❑ Distance to nearest lot line------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------I-------------------------------------------------------- ----------I---------------------------------------------------------------- ------------------------------------------------------------------ describe)---------=----------------------T---------------------------------------------------------------•------------------------------••------------------------ F w } -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- _____________________________________"-----_-_-__- __--- _-------..------------------- ___i-_.._-.--- I hereby certify that I have prepared this application and that the work will 6e-done in accordance with San-Joaquin County ordinances, State laws, and rules ndQgulat,Fonsfof the San Joaquin Local Health District. , 6n,41..c�: (idly iv : Septic Tcnot Scrvice g (Signed) -- ••' ---- ---------------------- ------. Contractor) -•-•----T��6 So.ltitio"ractc)---i-:`:��-7�-5�---------- -- - By:........ w.. �tQ1rktQ01_Galif-------- ------------------ ----- ----------------- ---•----(Title)--- ---=-- --- ------------------------------------------ (Plot ---------------------------------- (Plot plan, showing size of lot, location of system in relation to lis, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY-- ---- - --------•---------------------------• DATE------ ---- -- REVIEWED BY------------------------------- ----- ------- -------------------------------------- DATE---- i' '---------------•--•------..--.----------- BUILDING PERMIT ISSUED-------- - ------------------------------------= DATE-------------•----------------------------------------------- Alterationsand/or recommendations:---------------------- - -------------------------------------------------------------------------------------•------------------------------ -•-------•------------------------- ---------------------------------- ----------------------------------------------•----------------------•-------------------------------------•-•---------------------------------------- ------------------------------------•----------------•--------------------------------------------•-------------------------------------------------------------------------=-------------•------•---------- -------------C; ------ ------- —---- ------- -------- -- -------------------------------------------------- - -- ----`- --------------------------------------------------------------------- _ _____________/ter - __._;________.______________. P I -4.4 FINAL INSPECTION BY:I �f-i =----- Date-----r - ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street - 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stocktonr California Lodi, California Manteca, California Tracy, California ES---9-2M . Revises )-57 F.P.CO.