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APPLICATION FOR SANITATION PERMIT Permit No. - ------------------ Date C _G / 9 (Complete in Duplicate) -- ------ � 7141-1 Application is hereby made to the San Joaquin Local Health District for Date issued -_----This application is made in _compliance with County Ordinance No. 549. a permit to construct and install the work herein described. I . .. JOB ADDRESS AND L TION__--__ -___ . --- Z/1-0---------------- Owner's NameF - •----_---------Address__. . -------------------------------------------- .. Ph _ �_ -- OR Contractor's Name" ---------------- Installation will serve: Residence Phone, _-�- Apartment House ❑ Commercial ❑ Trailer Court Number of living units: --�_ Number of bedrooms ❑ M°tel ❑ Other (] Number of baths _ Lot size --- r- Water Supply: Public system X.-d71____. Communifiy system ❑ Frivafie ------------------ i er Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy❑Loam e❑ to Loam El ft. 1 � Y ❑ Adobe ,�� Previous Application Made- Yes Hardpan [] r ❑ No [�}�w Construction: Yes ❑ No HA/VA: Yes 0 No ❑ TYPE OF INSTALLATION 'AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or'cesspooi permitted if iblic sewer is available within 200 feet.) Septic T Distance from nearest well __"---Distance from foundation: No. of compartments------ �/ ` S -Mat/e_riai, I ----Size__ --- 3" ---------Liquid depth-- r - i§po al Field: Distance from nearest Weil _-_.Distance from foundation------ -__"-- Capacity-..___ Number of lines-_--____________ -----.Distance to nearest lot line_______________••,,,,I -Length of each line-__---------- --.............Width of trench--_.__--_,--- _ �r Type of filter material-------------------------Depth of filter material------=_------__ 6. Seepage it: Distance to nearest well_--______--__ --_Distancefrom foundation--------------------Distance go nearest lot,line----.___--_-_--_ ❑ Number of pits_.s------------------Lining material---,--------_- - Cesspool: Distance from nearest well-__"____-__ S+ze: Diameter__--__-____..__---___Deptn"------- Distance from foundation--------------------Lining maferiaj ..... Size: Diameter---�' ----------------- ------Death-----------------------------------------_ -------Liquid Capacity -------gads. Priv - Y- Distance from nearest well _.___----------------------------------------- ------ ---- ---- �y,, ---Distance from nearest building Distance to nearest lot line___ g----------._----- -- ------- ----------------- ?� Remodeling and/or repairing (describe):--------______--__-- ----------------------------- ------ ----------------------------- ---------•---------------------- -------------- ----------------------------------- ----------- ----------•-------•----•-------------------------- ------ I hereby tify that I hav re ared this application and at the work ' e done in accordance with San Joaquin County ordinances, to laws nd r regulations of the San aquin Local ealt District. (Signed)--------- I . -----Teo ----- By:-----------------------•------ ------- and/or Contras �� ------ ---- - -------------------------------------- - Re d/o Contractor) �' (Plot plan, showing size of lot, location o system in,relat n to wells, buildings, etc., can be placed on reverse side. ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----_-__!- _ REVIEWED BY ---------- DATE BUIL ----- ------ ------- ----- ---------------------------------------- DATE--- .----- DWG PERMIT ISStJEp-_____•___-- --- -`--------- ------ ____ A terations and/or recommendations---- ---- -------. DATE-"-_- Fi --------------------------•------------- } - -------------•---- ------------ ------- ---•----_-- - --• •._------"._"__--_-" � lk'11� FINAL INSPECTION BY-- ---------------ev -------------------------- Date--- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street Stock+on, California Lodi , California814 North "C" Street Manteca, California Tracy. California ES-9-2M Revised 1-57 F•P.CO.