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1 CIO 3 Zug he- y- APPLICATION FOR SANITATION PERMIT Permit No. 13.x, _v (Complete in Duplicate) Date issued Application is hereby made to the San Joaquin Local Health District for a per it to construct and install the k herein This application is made in compliance with County rdinance No. 549. ,E -- �� , - JOB ADDRESS AND L CATION _ -------------------------------- v , Owner's Name--- --- - ----- ,�/`�_ fl/i -�= t -- ------------------------------------------------ Phone----------------------- ------------- Address---------------------- ------ ----- Address-•-------------------- ---- -1---�Y"---------------------- - ---------•- -- --- ------ •---------------- - ...................................................... Contractor's Name-------------- -- -- ------------------------------------------------------------ --- -------------------- -------- Phatfe.............. .................... Installation r if ierrve. 'l ei-C6,kc r#ment.House-Q Commercial-a--Trailer Number of living units: __.,Number of bedrooms ---�__ Number of baths ___I-._ Lot size .- S-;F 5--:/- -�----- -----•=-------•- Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam El Clay Adobe❑;, Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ix No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool permitted if public �ser is available within 200 feet.) Sep ls Tank: Distance from nearest well /Q _Distance ro f ndation_.._/40 ...Ma4erI uid de h------- �Q... No. of compartments " -Size. m ' - q p$ ------. Capacity Disposal Field: Distance from nearest well _. Distance from foundation -Q_ DistP,nce.to nearest lot Iin ( y Number of lines_-.------------- --------- __Length of each line_ . " idth of trench -- t !�. Type of filter material._._S" epth of filter material------/ .....---Total length--------- Seepage Pit: Distance to nearest well_ ___________________Distance from foundation--------------------Distance to nearest lot line----------------- 0 -- -_---.❑;- Number of pits--------- ----------Lining material-----------------------Size: Diameter-------- ------.-----Depth---------------------------__-- Cesspool: Distance from nearest well__._______________Distance from foundation-----------___-___-.Lining material----_ .-_._.____._---------------- Size: .-----Size: Diameter------ - ---- ---------------Depth---------------- ----------------------------------Liquid Capacity------------- •-----------gals. =; Privy: Distance from nearest well____________ _________ Mance from nearest building_.__=_.__.______ ............. ❑ Distance to nearest lot line---------------------------•--- . ------. -------------------------------- ---------------------------- Remodeling --------- --Remodeling and/or repairing (describe):--- --.4.. . �------------------- . . ••----- -- - ----------- - -----•------------ ------ -----------------------------------------------------------------------•-•---------•-•----•---- ------------------------...... -•------ .. ............. - ------------------------------------ --- ----- ------ - ----- --- - - ----• ---= ----------------------------------------................----------------------- - ---- I`hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, ordinances, fate laws, and rules,and reegula ' ns of the San Joaquin Local Health District. (Signed) t --1 r \T -------------------• ---•----- ••--_ - -__._..- ---- ---------- ._-(Owner and/or Contractor] ;-00j - IF? %'�- Z: ------------------------------------------- ------ - -- -- . _.(Title)----- --- -------------------- ------•- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------- ---/----- --- - ----------------- ---------- DATE --------------------- ----- •------------------- REVIEWEDBY---------------------------------------------- -- ------ ---- DATE 7 - BUILDWG._P-RLYiIT ISSU_E_D, v � _�_ _-- DATE_ "--' Alterations and/or recommendations----------------=-- ----------------- ----- --------- - ----•--• •---•-. -' ------ ----- -•----------- -- -------- -- --------- --------------- FINAL INSPECTION BY:. ----------------- SAN ---------- 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 8-51 Revised W-2100