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• <br />I hereby certify that I have prepared this application'and Wet the Work will be done in accordance with San Joaquin County <br />ordinances, Sfat ,Jests, and rules and regulations of the San :Joaquin LoCal Health District. <br />(Signed) <br />By: <br />(Plot plan, showing size of lot, location of system in <br /> dialicker...and/or Contractor) <br /> (Title) <br />&Hon to wells, buildings, etc., can be placed on reverse side). <br />FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT Permit No. <br />(Complete in Dup/icate) <br />This Permit Expires 1 Year From Date Issued <br />.4Dplication is hereby made to the San Joaquin Local Health District for a permit to cons ct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS AND yo CAT I 0 N '" 1.24./.-e.,-,.)c;01e-rif I( .47a--r-sk 9 — 06 7 -2z0 -4_5' <br />Owner's Name -•grn <br /> <br />.t.einrt i- <br />± <br />el e."4- <br />fe <br />.,... <br />-k-9's:M <br /> <br /> se4 <br /> <br /> Phone <br />Address , i <br />e <br />• <br />Contractor's Name .• Phone <br />Installation will serve: Residence 1?1'....'8'.partrnent House 0 Commercial 13 Trailer Court 0 Motel 0 Other r..., y <br />r <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />Data Issued <br />Number of living units: Number of bedrocims 2 • Number of aths 7/....-Lot size <br />Wafer Supply: Supply: Public system 0 Community system 0 Private Depth to Water Table ft. <br />Character of soil to a depth of 3 feet: Sand 0 Gravel 171 Sandy Loam D Clay Loam D Clay 0 Hardpan <br />Previous Application Made: (If yes, dote / No CI New Construction: Yes 0 No fi FHA/VA:4 Yes fi No 0 <br />r <br />Seepa Pit: Distance to nearest well /0 .1 Distance f mFoundation /LI Distance to nearest lot line ..g. / <br />Number of pits ...,,.2 Lininy material X 0 Size: Diameter. 33 "Depth.....25."°-' <br />Distance from foundation Lining material <br /> <br />Depth gals Liquid Capacity <br />nearest building <br />r <br />Septic ank: Distance from nearest well..,c5.1V /_Distance from foundjtion r! 0 ' Material ego--te-121--- <br />t No. of compartments .P.-- Sizeerrtc-S7 /..Liquid depth._ fA• / Caplcity../51,V <br />Dispos Field: Distance from nearest well.i...PC Distance from foundation. IS i Distance to nearest lot line_S i k I <br />Number of lines <br />ma <br /> ti„,., , <br />- <br />Length of each line .1 C 0 Width of trench .v., / r <br />Type of filter terial _.....o..R. .___De th of filter material // 0- Total length cP e' 0 ' _ - I p <br />Cesspool: <br />0 <br />0 <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Distance from nearest well l• I <br />' I Size: Diameter t 1 <br />f <br />f Distance from nearest well . Distance from <br />1 Distance to nearest lot line <br />Remodeling and/or repairing (describe). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY DATE .............. <br />REVIEWED BY DATE <br />BUILDING PERMIT ISSUED ......... .. ...... DATE <br />Alterations and/or recommendations: <br />FINAL INSPECTION BY: Date <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hamilton Ave. <br />Stockton, California <br />CS 9 REVISED 9.59 314 3-63 F.P.CEI. <br />300 West Oak Street <br />Lodi, California <br />124 Sycamore Street <br />Manteca, California <br />205 West 9th Street <br />Tracy, California