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APPLICATION -FOR SANITATION PERMIT. Permit No, ---- ------ (Complete in Duplicate) Issue Date d Applica4,ion is hereby made to the San Joaquin Loclal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 4 ------ LOCATION--,_ �IW;5: --- - Phone Address----------------;------ w ........Mrv Owner's Name-----11 Address---------------------- ----------- ----- -------------------------------------------------------------- ---------------------- Contractor's Name------------------------------ ---------------- ----------------------------------- Phone--------------------- Installation will serve: .,Residence F Apartment House Mff Trail 7 Court E] Motel Ej Other E] Number of living units:him- Number of b'e'j rooms 491��Number of baths I Lot size -------- -- -- ------ -- ----------- Water Supply: Public system 04-10cormunity'systerri'E] —Private'E] 'Depth to Water Table Z; ft. 4 & .J. Character of soil to a depth of.3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay El Adobe L?KHardpan E] Previous Application Made: Yes E]- No New Construction: Yes E] No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) TW-Distance frorn,ioundationlJO!--------M ? S e p tic*'7T —k: Distance from nearest well-44P4, , , - io V i f aterial---- V�------------------ V, compartments--.12 ----- ----------------------�&iql'icl depth---;�---4V---------- Capacity-----I-XA79-d"- No. of -------!�,' e4, Disposal Feld: Distance from near f welX11-01--l-Disfance from foundation-----/----0-----------Distance to nearest lot line---- Number,of lines___ -------- ------------- ---------t-------P Length of each line__-.-ff---0---------------Widfh of trench._ -------- Type'67 filter material---1-1V!-------J---Depth of filter material......1S."'----Total length------/-00------------------------- Seepage if: Distance to nearest wellXtO -)eDistanc--4rom foundafion--/d---f..Disfance to nearest lot line----,r-`---_ Number of pits- 1'_-_-----------Lining--- -----------LiTng material--#0,m in Diannefer-13"---------Depth------Zd2-------------------- Cesspool: Distance from nearest well---.-- "-__-------Distant m foun P�-------'------Lining.maferial------------------------------------- El Size. Diameter--------------------------- ---------Depth.----.-----------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------I-----------------r--------- --------------Distance from "nearest building-}--..--------:---_._.--------------.-.-. FT —i—Disfance to nearest lot line--.-----------r------------------------------- --- ------------------------------------------------------------------------------------- Remodeling and/of repairing (describe]:----:__ ------ --------------I------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- 0 -------*------------------------------------ - -----------------------------------------------------------------------------------------:--------------------------------:-------------------------------------------------:----------------------------------------------------- I hereb certify that I have this application and that the work will be done in accordance with San Joaquin County ordinances, fe laws. a d rulelaf`ions Of the San Joaquin Local Health District. 0 1G*ner=an4�- qr Contraictor) (Signed)--- - - - ----------------------------------------------- - -------- ------ ----- -------------------------------------------- o ------------ By:------------------:-------------------------------------------------- - ------------------------------- ----------------- 71-1 (Plot plan, showing size Of lot, location'of system .�'relafion to wells, b dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-V.. .-- DATE --------------------------------------------------- REVIEWED -------------- ------------------------------- REVIEWED BY------------ --------- --- - - i------------------------- DATE--:Ca BUILDING PERMIT ISSUED---------------------------------------- ----------------------------------------------------- ..... DATE..-.'---------------------- ------ ------------- --- -------•••-------------- ---- ---------- --------------------- ------- ----------------- -- Alterations and/or recom*dal*ors- ------------------------------------ ----------------------- - ------------------ ------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------ ti ------- -------- ----------------- ------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------------------------------------------------------------------- FINALINSPECTION-BY: tv1 --------------------- --------------------- Date---- - --- --------------------------------------------- --------------------- SAN JOXQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak "'*a' 132 Sycamore Street 814 North "C" Street Stockton, California Ldi, California Manteca, California Tracy, California ES-9-21M ; . Revised W-2100