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/ j5_e�41� �7 gPL1CATION FOR SANITATION. PERMIT . Pe it No3_ -f____.... (Complete in Duplicate) " l Date Issued --- --- -T---- f Application hereby made to the S ' q p Jaa uin Local I-Isalth District fora ermit to construct and install th work herai described. This application is made in complian with County Ordinance No. 549. r F 1 JOB ADDRESS AND LOCATIO U `S` = ------- 9�' one •--- Owner s Name / �� -- ---- - --- --- .s .. -- ea. l4. - -- -- -- Phone_______ __ ---------- --- 000 Con#ractor's Name.-- � -�------------ - ---�-�- --- ---•- - Installation will server Reside ce ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ �/Mo#el er ❑ Number of living unit:�Zmunify- ber of bedrooms -l�---- Number of baths A--- Lot size ___6r ___ _._/--- •- Water Supply: Public sysia system ❑ Private ❑ Depth to Water Table. _Q ft. Character of soil to a dep h of 3 feet: Sand ravel E] Sandy Loam E] Clay Loam E] Clay El Adobe ardpan ❑\ Previous Appliceton-.Made: Yes ❑ No F New Construction: Yes No ❑ I TYPE OF4INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: _ Distance from nearest well______________Distance from foundation....._--__________.Material______._______________________________________. []�,t�ir r No. of compartments-------------------------Size--------------------------------Liquid depth- -------------------------Capacity-------------------- �l Disposal Field: Distance from nearest well________________Distance from foundation_____ _.:'____..Distance to nearest lot line________________. a .r Number o3 lines------------------- ------Length of each line---_-.---=------------------.Width of french.------------------------------.... ` Type of filter matenal_________ _______ _ --- epth of filter mate'rial-----------------"-----Total length_---------------------------------------- �K �!�/ __Distance from foun ation__ __�___.__:_..Distanc to nearest lot line__ Seepage Pit Distance to nearest well- & _______ _ ` Number of pits---- _. Lining material___ ,rla� Size: Diameter_,-.._ _ ._�.____Depth____.... �_ Cesspool: Distance from nearest well-______ _________Distance from foundation-_------------------Lining material------------------------ ---- ------ n—_I e SizE--D.iemeter._- -------- ---- --L•squid CepacitY —_ :;_;• = gals. ��. . - _ -... Depth , .. - Privy: Disfance from nearest well-------_-----------------------------------------Distance from nearest building_______ ❑ Distance to nearest lot line-------------------- ------ - ---- ----------------------------- ti Remodeling and/or repairing - (descri"b"-e)----------A--- --------------- --- -- - -------- --- =-- ------------ ----- - -- ----------- -- -------------------------•------------------------•-------- - -------------------------- ------------ ------- ------------------------------ ------ ----- -------- � ----- -------------------------------------------------------------•-/------------------- ------------------------------- ---- , --• -------------------------- I hereby certify that I have prepared this application and tha the work will be d e in accordance with San Joaquin County ordinances, State ws, and rules and re ulation of the San Joaqui Local Health District. Ow and/or ntractorl (Signed)-------- -- ------- --- ------ Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY--- =-------------- -------------------------- -------------- DATE REVIEWEDBY == ---------------------- ---------------------------- DATE ---•- = BUILDINGPERMIT ISSUED---------------------------------- ---------------- -------• ---------•----------------------------- DATE..---- -------------------------------- --------------------- Alterationsand/or recommendations--------------------------------- -------------- ------•----------------------------------------------•---•=----•-----•-•---------------------------••--•-------- 1 -------------------------------•----------------••------------------ -•------------I----------------------------------------------------------------- ------------- -------- ------------------------- ----------- -_: „, --------------- --------------------- - --- - ------ FINAL INSPECTION BY:. l--- -- - ------- Date.- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mahteca, California Tracy, California 9-2M 10-52 Revised W-2100