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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ev I Y_ JOB ADDRESS AND kOCATION_-Q.0------- -2--'- ----------ez_�_------------- Owner's Name.- ---- .... 4- t 77 ------------------------'-----------'----------- Phone------- Address Address--------1L..1 k--�/o- aa --- ----------I ---------------------------------------------------------------------------------------------------- Contractor's Name------ -------- --------------------------------------....... Phone--------- Installation will serve: Residence Ej Apartment House E] Commercial 0 Trailer Court [] Motel E] OtheAr _i� Number of living units: Number of bedrooms -------- Number of baths -------- Lot size ------ 6 Water Supply: Public system ❑ Community system El Private Ar Depth to Water Table _70tt Character of soil to a depth of 3 feet: Sand E] Gravel Sandy Loam El Clay Loam Clay E] Adobe pan Ej Previous Application Made: Yes F] No� New Construction: Yes Ef-.'I'To HA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 f et.) Septi5,Xank- ,e once from nearest welljs-a----Distance from founclaijon.,26.1.7...Mafe al....0-C,—--- --- - -------- .'o. of compartments---9------------- -----Size-,". *id deRth------ ------------Capacity../ --- Disposal Field: 0 Distance from foundation_ 1--S----Distance to nearest lot lin T;V Distance from nearest well- - laa ------- Number of lines.... _Length of each line....._70--- .......Width of trench---1?e.jo..... Type of filter material --Depth of filter material-------J_j--------Total length......1?13------------------------- 6w Seepage P- - Distance to nearest well_---- Distance from foundation---110-------Distance to nearest lot E?� Number of pits---;----------------Lining mateeNt-7-7-77-7-7-Size: Diameter----__3/6_-336pth_.1A_4 Cesspool: Distance from nearest well-----------------Distance from foundation------------ ---Lining material.__.-..-._..._._._a ------------- 1111a F1 Size: Diameter------------------------------------Depth--------------------------------_--------..-.-Liquid Capacity-----------------.....gals. Privy: Distance from nearest well-----------------------------------------------Distance from nearest building_____---_.._....._______________ ❑ uilding---------- ----------------F1 Distance to nearest lot line------------------------ ----------------------------------------------------------------I----------------------------I------------ Remodeling and/or repairing (describe) 14"_ ------ ..4",t__4i44Z�__--------- -- - - ............. _;;Ot------ - -----%_ ___ ..... --------- ------- I--------------------------------------- ---------- -------------- ------------------------------------------------------ --........------- ---- ----------11----------------- ----------------------7--.... ................---------------------- ----------------------------------------------------------- ------------------- I hereby certify that I have prepared this application and that the 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)-----�AA ------------------- ----j1I9v#raPwaw&oi)6* Contractor) --------------------------------- ----(rifle)----- By:---_----------------------......---- --- 011�1 ---- -_--- -- - (Plot plan, showing size of lot, locatii of system in relation to wells, buildings, etc., can 69 placed on reverse side). �;i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___._._._...__.__.....__..___- DATE...._.._..._.___... ................ ---- DATE----------- REVIEWED BY..--------------------------------------------------- --- BUILDINGPERMIT ISSUED-------------------------------------------- -------- -------- DATE-------------------- ----------- ------------------- Alterations and/or recommendations------------- ------ -------------------------------------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------- -_---------------- --------- .. .................................................----------------------------- -------------------------------------------------------------- ----------- - ......... ------...... - --- .--_-------------------------------------- ...---------------------- im ---------------------------------------------_-------------- -------------- --------- - ----------- ------------ ---------------------- ------------------------------ FINAL INSPECTION BY:------------------- ---- ---- ---- ---- Date ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 So.fh American Sheaf 300 W.0 0A Street 132 Sycamore Street 814 North "V' Straat Sfo.ktn, California Lodi, California Manteca, California Tracy, California ES-9-21A . Revi..a 1.57 F.PSD.