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,-APPLICATION FOR;SANITATION PERMIT Permit 04.-. ..f (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. � �ZJOB ADDRESS AND LOCATION---- ° ---- --- �. Owner's Nam ----Srv`�� 1 Phone *_4 Address t' i------- ----- ----------•-•----=--------- `� Contractor's Name----------------------- -----. '[�C� -Cf- ---------------------------------- Phon ,, ---... 7--- e _ .-� Installation will serve: Residence [�]/partment House ❑ Commercial'*❑_T ailsr Court ❑ Motel ❑ Other ❑ .. '' Number of living units: __+r__ Number`of beciroo=s 4-t-;___�Nu Number of baths __ __�__ Lot,size 1_4- __-�_`f-f _ ______________________ Water Supply: Public system system �❑ Private'❑ Depth to Water Table `��_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gra del ❑ Sandy Lome❑ Clay Loam ❑ Clay ❑ Adobe [T-Iiardpan ❑ Previous Application.Made:, Yes ❑ No Pt I New Construction: Yes ❑ No FHP,/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) tic Tank- Distance from near'es# well-�______________Distance from foundation------------- ------Material-----------------_--_--__-___________..______--. No. of compartments---'------- ------ -----Size--- ---------------.--°•_.Liquid depth--------------------------Capacity----------------------- I � i � r . ,,ate is sal field: Distance from nearest well______________'',Distae from foundation_:;�.____ _.....Distance to nearest lot line----------------- Number of lines_-__.!_______}________________ _Leng#h of each line:=---------------_- t_----Width of trench----___--------}. .__:__------ ___: Type of filter material___ ______________ _ -_Depth of filter mate�riaL- .______(_____-___.__Total ength Q � r D �a�ai� un atioriSeep g Pit: Dis#antetoeare1w�Il /�0�- / �� en to-inear Number ofpits--- g } y��iz : Dieter 11 c S -- � Cesspool: Distance from nearest'well------------..____Distance from foundation_____...__._ ------Lining I 1 -- materia l__________________________ ____ ❑ Size: Diameter.------1 4------- � ----- ------------------ Dept __-- -____Li Liquid Capacity----------------------------g t Privy: Distance from nearest:well_________________.______ _ ______-Distance fromInearest buildin ---_---- i . , _ � t 9 ❑ Distance to nearest lot line----------------"--------- ---- -— --------------=----- ----------•---------------------------- i Remodeling and/or repairing (describe):- 1 I ---------•--------•-----------------••-------------------------------•------------------ -= ------------- ---- € 1 ! ----- ' == - I hereby certify that I have prepa -•----------------•--------.-..-------------..--------------------- rethis application a d nd that the work will be done in accordance with San Joaquin County ordinances, Sta a s, and rules and re-milafions of the Sari Joaquin Local Health District. (Signed)-------- -- -----------""------. -- -... ---- (Owner and/or Contractor]- j, } 1 By---------------- fel = Title C ------------------ ) (Plot plan, showing size of lot, 'location'of system in rela n to wolfs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------------ -------------- ------------------------- DATE BY DAT �� BUILDING PERMIT ISSUED - DATE r Alterations and/or recommendations:-------------- -------------- ------------------------------------- -----------••------------- -------- ---•---•------- •-- ---- �� ----- ---- ------------ ------------- -•---- - L. _.. . ---•---•------ --- -- -- ---- ------- - - ---6-------- FINAL INSPECTION BY:_-_ _ __. - ----- -- -------- -----------__.- -- Date-- -- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Reviseky 1.57 FRIZO,