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- - - �� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) V �J Date IssuedTO T— Application is hereby made to the San Joaquin Local ealth District for a permit to constr t and install thew herein described This application is made in compliance with County J&rdinance No. 549. V 2J 4* C- 144tJ—-dPVC - - 9 / ZA4e JOB ADDRESS AND LOCATI ,N.._._ Tom._ ----- 1 Owner's Name_ �,e--_ _ m„9'' • --�� - - -K--- ane-- --------- - - P Address -------- ------- Contractor's Name------------- ----- ------------------------------------------------------------ - Phone_ -.• Installation will serve: Rest encu Apart nt House ❑ Commercial ❑ Trailer Court ❑ Motel I Other ❑ Number of living units: __ ___ Number of bedrooms-_ Number of bathsAeLot size _ --- ---- •__________________ Water Supply: Public system E] Community system C] Privateer'` Depth to Water Tabl ft. f Character of soil to a depth of 3 feet: Sand E-] GravelE] Sandy``Loam ❑ Clay Loam Ll Clay ❑ Adobe Hardpan ❑ ` Previous Application Made: Yes ❑ Nox New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_ Distance rqm fou d�tion-_�®____.___.Magi I_�.•-tx-- __- ! ------ No. of compartments-__ _______________Size___ _______Liquid depth__ � Ca aci C�� ----- i --- - �''--- --- tY----- -----; Disposal Field: Distance from nearest well_�� ___.Distance from foundation ---------Distance to nearest lot line _ W Number of lines____________ ____________ _ Length of each line______ l - --- -�----f-f�---Width of trench------�'-r�--�;�---------------- Type of filter materia(_ / .__-Depth of filter materia-----t"" Total length---------- - --------- Seepa e P3#: Distance to ------------� ____`.__.Distance to nearest lot line_---. nearest well_ � �_rDistance fr m fou ation_ �. 1 Number of pits------ ------------Lining <materi Size: Diameter___-,f , ____Depth_______-Q�_Q f Cesspool: Distance from nearest well-----------------Distance from foundation-------------------/Lining material----_----------- ________-___-_________- ❑ Size:Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------ --------------------gals. ` Privy: Distance from nearest well ______------------------------------------------Distance from nearest building------------------------------------------- ED Distance to nearest lot line------------------------------- -------------------- Remodelin and/or repairing describe . --------------------------------------------------------------------•------------------------------------ -------------------------------------------------•- ..•-- -------------------------------------------------------------------------•-------------------- ------- ------------- i-------------------------- ---------------------•----------------------------------------------------------•----------------------------------------•------------.---------------•- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordina-- nces, State w and rul nd-,regulations of the San Joaquin Local Health District. 0—(Signed) ________- -----Owner and/04., o tractor BY: ---- f f.� = ----------------------- (Title --- {Plot plan, showing size of lot, to t' n of system in relation to wells, buildings, etc., can-be p aced on'rever•e side. s �- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------•-------;?_1--- ---------`--------------------------------- DATE---------- Y-- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDINGPERMIT 'ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------- Alterations and/or recommendations:------------------------------------- ---------------------------•-------------------------------•--------------•----•-- -- ------- : ----- ---------------- --- -------•--------- ------------ 1----------- � J -- ----- ------=--------------------- ------------------------- --, ----------- ---------------- - ---- -------------- ---------------------- - --------------------------------------------------------------t---'---"----"-----=---------------------------- ________________________________________________________________________________________________________________ ----------.____________--____...______________-___--_______.._______-,-__.---_-fi_-_-_-_-r_.-_.-_-b_-_.- -_-_--_---_-_-_---_-_-_-_-_-_-_-_-_-_-_-_-_-----_-_-_ FINAL INSPECTION BY: -��'F - ------------- Date .fI JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 5-51 Revised W-2100