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APPLICATION FOR SANITATION PERMIT Permit No.7 _ i--7... (Complete in Duplicate) Date Issued __x7-.!/_"�_7z' Application is hereby made to the Sa Joaquin Local Health District for a permit to construct and install the work herein described. p' This application is made in compliancedCh County inan No. 549. - a -�. .< JOB ADDRESS D CAfiION -: -------- ---------•------- --- Owner's Name--- -- ----- ------- - -(-------- --------------------------------------------- ------------- -------------------------------------------------------- Phone-4--47-4 I Contractor's Name-•-- ------------- -- - ---- - - --- - ------------------------ -- - --------------------- ----------------------------------- Phone------------__------------------- Installation will serve: Residence E] Apartment House E] Commercial Trailer Court ❑ Mote) ❑ Other [_1 Number of living units: ________ umber of bedrooms -______ Number of baths ________ Lot size __ �___ ,__�_ 1 _�-------- --------- Water Supply: Public systemommunity system 'ElPrivate ElDepth to Water Table -------- ft. 'Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Laam Clay Loam El Clay E] Adobe �ardpan L]Previous Application Made: Yes E] No New Construction. Yes ; No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ' ublic se r is available within 200 feet.) r 1_0` Septic dank: Distance from nearest well �_ sta ce fro lfou bion-------1.0----.Mate a�l--- --------- - ---- - ---------- [� N,o. of compartments-------�--- ---------Saze-- -- X ----Liquid depth---------------------Capacity------- -Q----- Dispos I Field: Distance from nearest welIWIP4a Xistance from foundationf _ ___ �Jistance to nearest lot lin _ ��T [; Number of lines________ _ ___ __ _________ _Length of each llne_I_pY.-". -.Width of french__._ _ � g 41 Type of filter materi ' _}},--,,,, p Q - 9 1i,��De th of filter material _ ______Tata# length ____________________ x Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_.___-____:_____. ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------.---------------.Dept h------------------•-------------- - Cesspool: Distance from nearest well----- -----------Distance from foundation _ _ _ C _______-Lining material__ ___-__ ____,_-__________ _____-, 0 F1 Size: Diameter-------------------------- ---- p -----------Liquid Capacity----------------------------gals. _ Privy: Distance from nearest well-------------------------------------------- ___Distance from nearest building---------------------------------------._. _j ❑ Distance to nearest lot line------------------------------------ -- ; ----------------------------------------------- Remodeling and/or repairing (describe):-------------------...................... - l ----------------•----------------------------------------- ---------------------------------------------------I --------------------------------------------------- ---•--..... '---------------- ---------------•---------------•------- ------- -------------1-1-----------I ----•------------------------------•----=-------IN----- ' .............../--------------Z-----------------------------------------•---------•-------------------------------- IV5 --------------------------------------------------------------------------------------------------------—;----------'---------- I hereby chrtify that I have prepared this application and--that the work will be done in accordance with San Joaquin Count ordinances State laws, and rules nd regulations of the Sart!Joaquin Local Health District. f ------------------- {Owner and/or Contractor) F �By----------- -------------------------•--------------------------- ------------------------------------------------------------------(Title)---------------------------------------------------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------------------------- ---------------------------------------------------------------- DATE;.j_e-- BY.------------------------------- ------- - ------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED -- ----- - - ..--------------- DATE - -- Alterations and or reco mendations:_____ ___ _-- ` � - ---- !-`= f - --- ` f (. 1r '� `� ------ ------- --- fl- -�-- 's_. ._t_ n c U----- -----= � c `r (� %i - ' 1_- -i-�•_ -j' ,-'�--� dna�=--- - --- ---- - -�= f rr.(( FINALIN�TION BY---------------- t �} ----------------- ----- Date-------------------------------------------------------A----------------------- SAN�OA uI� CAL Ei EAL D�RiC -- <� GQ is- 1q 130 South American Street 300 West Oak Street 132 Sycamore Street 814 14h C Street Stockton, California Lodi, California Manteca, California "'Tracy, California ES-9-2M B-51 Revised W-210011W AV� Al �� /f�1 VL1 45W/ 1_111