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APPLICATION FOR SANITATION PERMIT A`PemitNo. ._ti.t l i i------ (Complete in Du plicatez� � Date Issued ----- ---------- -S� 9 7s0 Application is hereby made to the San Joaquin Local al#s rrc or a permit to tr ct nd 'ns1 11,th erein desL71-�-1 Thisapplica tion is made in compliance with Coun�7l"Ordinance No. 549..JOB ADDRESS AND LOCATION , ---•-•----- ----------------------- . ---• -- Owner's Name------------------------- --1----- --- ---------- ------------ ---- .------- Phone------------------------------------ Address �---- �-. •------------ - - -:-I- ----------------------------------------------------- ContractorsName---------------------------------------------------------------------------------------- ----------------------------------------------- Phone.----•---------------------•------- Installation will serve: Residence N Apartment.House,❑—Commercial ❑,Trail"er Court ❑ Motel ❑ Other ❑ I! Number of living units. I---- Number of bedrooms._`�__ Number of baths --/-__ Lot size __-��l�Y�__Aq__ --:______•____ 1, Water Supply:. Public system X Community systerrijjj—� Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay oam E] Clay E] Adobe 5 Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No Lif iA/VA:Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: !i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � A Septic Tank: Distance from nearest well, Distance from foundatio r _ � Material--- _11,eejY�e-/ - No. of compartments-------��r------------Size : --;�__-----Liquid depth--�----------------Capacity---- -a-- Disposal Field.', Distance from nearer . well_ -_'_w •a�istan from found tion" l --------------pistance to nearest lot line-_J '�'`►i•�� --I- .-Len th�o�F''eac€i�ine- Number of lines-------- ,r g Width of trench �'�"` Type of filter materia---St-�e Depth of filter material-_J?------------ length_--- �-------- Seepage Pit: Distance to nearest well----------------- Di' e fro foundation---=;:.-------------Distance to nearest lot line----------------- El Number of pits----------7----------Linings material-'--,-Y o-_..-__-- ..Size: Diameter----•-----'-------------Depth______________________-_______-- Cesspool: qq Distance from nearest:well--__--------t-_-Distance from foundation-------------------.Lining material_---------__------------------------- ❑ Size: Diameter-------------------------- -------Depth---------.------------------------------------ ------Liquid Capacity gals, 4 -Privy: Distance from nearest well ---:--.--------------------------------------...Distance from nearest building----___---._-------------_-_-------------- ❑ Distance to nearest lot line--------------i-----------------------------=-----------------•--- Remodeling and/or repairing (describe)-------------------- t ---------------------------------------•-------------•---------------------•----------------- �L k --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -_._--___----------__----_-___--__ - ------------------ ---------------------------------- ✓_ t ( E L I hereby certify that I have prepared this"application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' (Signed)-- --- -- ----------------------------- " ' --- - � `__-___-{Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Tit le)----•----------------------------------------------------------. (Piot plan, showing size of Io+, location of system in relation to wells, buildings, etc., can be placed on reverse side). -FOR EP TMK T USE LY APPLICATION ACCEPTED BY----- -- ------- _ ----"DATE....... ; REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------•--------a =----------------:------------------------------------------------------------------ DATE. Alterationsand/or a mendations:---------- --- - ---------------------------------I--------------- --• -----------------------------------------------------------------------------------• . ------%Ifkjl�----- -------I----------------- wou FINAL INSPECTION BY--------------W------------------------------------ Date-------------" ------ -'� .. SAN JOAQUIN LOCAL HEALTH 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 Revisea 7.57 F.R.Co.