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APPLICATION FOR SANITATION PERMIT Permit No. 11.4-14 (Complete in Duplicate) 0 Date Issued lt/----if7 Applica+ion is hereby made to the San Joaquin Local Health District for a permit to consfFSFane�insfVll fie w5rk herein described. This application is made in compliance with Count dinance No. 549. OB 66R IT LO ff7__E---- --- -X u --------- - Owner's Name____ ------ ------- ------------------ - --- -----•--- -------------- -------------- P(one -------- _AA Address 7 A14 _j-------------------- ---------- ------ Contractor's Name---,. 4 ----------- .....C----- ---------------- Phone---- Installation will serve: Res clen 0par+menf House [] Commercial E] Trailer Court E] Motel Ej Other E] Number of living units:�J---- Number of bedrooms Number of baths _/ Lot size Water Supply: Public sysferr�V ❑ ----------- Community system 5;�ivate El Depth to Water Table------- ft. Character of soil to a depth Of 3 feet: Sand E] I Gravel E] Sandy Loam E] Clay Loam [] .Clay Ej Adobe[a--qa_rdpan E] Previous Application Made: Yes 0 No New Construction: Yes J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest welkpp.`__Distance from fo _-.?e---------..Material-- tion Septic r No. of com' partments.- _,Z----------- ----Siz %`5-Liquid clepth__4577jj...........Capacity_42�_ ----2_4"" Disposal Field: from nearest we from 41 Distance r lines___91A__ �--Len --D's ante f 5< :0bRnda`f ion--3-10------ Distance to nearest lot line__%-57. Number 01 ...91A__ gth.of each line____S�a -- ----------Width of french------ Type of filter material r 54------------------1-811------------Total length----/-0--*-------------------------- ___Depth of filter material Seepage Pit: Distance to nearest well'40-0 Q---------Distance from fQunclafion__4_� Distance to nearest lot line_______1.5-- Number of.pits----.Z-------------Lining material__,_�_ -_Size: Dia mete r__441-1, Depfh_c;?-.0 ' ------- Cesspool: Distance fi'cm nearest well-----------------Distance from foundation------._.____--- -_.Lining material El Size; Diameter--------------------------- ----------De pt h----------------------------------------------------Liquid Capacit .y----------------------------gals. Privy: Distance from nearest we4------------------------------------------------Distance from nearest building------------------------------ ----------- ❑ Distance to nearest lot line --------------------------- Remodeling and/or repairing (describe):___.___.._______________ _ ----------- clescribe):-_---------------------------------------------------I------------------------------------------------------------------------I----------------- -------------------------------- ---------------------------------I------------------------------------- ----------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- -------------------------------------------------------------------------- ----------------------------------------------------------------------------------- -------------------------- I hereby certify that I have prepared +his application and that the work will be done in accordancewithSan Joaquin County ordinance$, and rulesw ,V9dlat.' f the San Joaquin Local Health District. v, , t U%j {Signed)----_-- septic Tank Service ---1206-50"EMora"---NO-2- 4--------------n--------4-------A---------------------------------� -a-ind/or Contractor) 6 _Pwner- By:--------------------------------------Spo_ck!o&.Cctlm-------- _-f7- ...........y (Plot plan showing size of lot, location of system in relation f ----- kj -------Title)--------- A,��t------------------------------------ �4 0 ells buildings, e rcn be placed on reverse side). FOR EP RTMENT USE ONLY APPLICATION ACCEPTED BY_____________________..__ REVIEWEDBY------------ --- ----------------------- ------------------ -------------------- DATE----------------- --------------------------------------- ---------------------------------------- ��, ------------ --------------- ----------------------------- DATE ---- BUILDING PERMIT ISSUED------ ------------------------------------------ Alterations and/or relcommenda"flons* - - ------------L f =------------------------------ - -- ------- - -- ------------ ----------------------------------------------------------------- --- -------- -------------- - ------------------------- ------------------- ------------- ...... . --- ----------- --------------------- -------------------------------------------------- !,---------------- ------------ --------------------------------------------------------------------------------------------------------------------------------------- ------------------I------------- - ---------------------- -------------- --------------------------------------------------------- ----------------------------------------------- -------------------------------------- ----------- ----------------------------------------------- ------------------------------------------------------------ -------------------------------- ------------------------------------------- FINAL INSPECTION BY:-----'_ .5-----_--- o � :� - ---------------------- Date-----�---- - -Q--�- ---- �--------------------------- -------------- SAN Y:------ SAN JOAQPIN LOCAL HEALTH DISTRICT ii a 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 ; :.Revised W-2100