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APPLICATION FOR SANITATION PERMIT Permit No. _3�.�7_ -(Complete in Duplicate) Date Issued— Application ----•-_--:- -.- t g� -moo- s� ..� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew rk hereintidescrib This application is made in compliance with ounty Ordince No. 549. �. JOB ADDRESS AND L Tf L ` Owner's Na Address_-.-- � , ----------------------------------- Phone1�9 - ----------------- ontractor's Name--__ ------------------------•__-_-- --p i ----- ------- c----------------------------------------------------- Phone--------------------------------•- - nstalla}ian will serve: Residence ❑ A artme House ❑ Commerc- ail r Court ❑ Motel ❑ Other ❑ Number of living units: �_- Number of bedrooms _ Number o Lot size •--+ _[ 6____ Water Supply: Public system .❑ Community system -❑ PrivateDepth to Water Table ._ - ft. . Character of soil to a depth of 3 feet: Sand IV Gravel E] Sandy Loam ❑ Clay Loam ❑ Ga Previous Application Made: Yes E]of: New Construction: Yes, No ❑ y ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) Septic Tankj` Distance from nearest well_ 50---Distance from foun n____ p' 1 �- .Mat id ------�,,.I�p No, of compartments___-__-- -------Size___ - � uid dep�h----- Disposal Field Distance from nearest well__._ ..i ---Capacity__ Q__ ? -_rfJistance from foundation__. ante to nearest lot line } Number of lines_ _ � � - -�- - •- - ---�_ Length of each lina__ Type of filter materiel_-__ __-- y gL� dth of trench__.___ l'"�'�E.}epth of filter material_____ Tth______ _ � ----- otal length �-----�--- Seepage Pit: Distance to nearest well---------------------- -------------- __________Distance from foundation--------------------Distance to nearest lot line________________. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth---------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- ❑ Size: Diameter-----# Depth- Lining material--------------------- --------_--- .1k— Priv , �- - Liquid Capacity------------------ ''g s Y istance from nearest well _______"'------------- - =� ---------- - -_-Distance from nearest wilding='_"t :=� ❑ Distance to nearest lot line �-�"- �Ied -------------------- ------------------- I� mopj- g (describe)------------ Lfr -✓ � _ --� --- - -- --- - _� -- --------------- - -- ------------------------------------ ------------------------------------------------------------------------------------ ----------•------- - --------------------------------------------- ----------------- _ I: 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a dinances, S}ate .Iph, and rules and egulations of the San Joajuin Local Health District, ` (SigneId)_ ------------------------ Ow By: ---------AiKe ii—I!":, .------. (Owner and/or Contractor I- ,r --------------- (rifle) -- ------------------------------- (PIot plan, showing size of lot; location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY ;i APPLICATION ACCEPTED BY_________-___-- -------�- ----- --- - - - ----------------------------- ----- DATE--------------- REVIEWED BY------- ----- ----- BUr1LDING PERMIT ISSUED - --.............. -- ----------....................... ---------- -------------- DATE-------- ------------ .r' 5 ------------------------- DATE ---------------------------------------------------------- -- --------------------------------------and/or recommendations:----------------__---- -_ ------ -- ------ ------------------------------ ------------ -------------------------- ------------------ ---------- -------------------------- ---------- ---------------------- ------------------------------------------------------------ -------------------- -------------------------------------- ---•--------------------------------------------------------------------------- --------------- FfNAL INSPECTION BY---- -----------�-- Date ------•----•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California } Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 j