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5 Ca MVT_ . Z) APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .................. Application is hereby made to the San Joaquin Local Health District fora permit cons ruct and install t ork herein escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A A ION------- '� - .. •------- Owner's Name '-- - Phone i Address - ��%' _ .�fL.asrx.GP. Contractor's NameY- ----------------------------------------•------------------------------------ Phone-_ •--• � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms 4____ Number of baths __1__._ Lot size ---- ....... ------- Water Supply: Public system ❑ Community system Private ❑ :Depth to Water Table __--___ ft. Character of soil to a depth of 3 feet: _Sand ❑,. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla obe e—i ardp Previous Application Made: Yes ❑ Nlew Construction: YeNo ❑ FHA/VA:Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIQNS: (No septic tank or`;esspool permitted i public ewer is available within 200 feet.) Septic Tank: Distance from nearest well_/M.. -_-Distance ��m fo , ion_. _.__..___Material . No. of compartments__-A--._-- ___,____Si ___oh _.__..Liquid depth__s �- ----------Capacity..&V_ _ r Di spo I Field: Distance from near st well -----Ot-anArom found ti n_1 Q._.___-..Distance to nearest lot line aF Number of lines_ - "� __(-Distan'ce Length of each line: _ Width of trench___ �� Type of filter material _Depth of filter materia_____/S...._...__Total length____ _ ,_ __- _,______- Seepage Pit: Distance to nearest wefrom foundation....................Distance to nearest of linz+_:.,._____._ --- ❑ Number of pits----------- ------Lining material-------:---------------Size: Diameter---•---__..__-.___-•---.Depth-----------•-------•-___.___.__._ Cesspool: Distance from nearest well______ ________Distance from foundation--------------------Lining material------------------------........ ❑ Size: Diameter-- Depth--- - •---- ---•-- -- - ---- ---------Liquid Capacity.................----_..--gals. Privy: Distance from nearest w --- ------------------____-. -.-.___.____Distance,from nearest building_____ ________ ❑ Distance to nearest to me ---- _-- ---- ---- ----- -•-•--•--------••-•------------••-•- -------- ------•---._.. ...._.------------ Remodeling -_ -.Remodeling and/or repairing (describe ------- -- -- --- --------- ------ -........... ....... .......... ..._. a ».„ --------------------------------- - ---------------------- -------- ------- ------- -----•-- ------------------ --------------------........................................-------------------- I hereby certify that I have prepax*d th1s_4W.lr.Atjon and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations'of the San Joaquin Local Health District. t &NIGHT (Signed) Septic Tank_ I O Z• Se7dl --- .._-- --- ---.,__ _W�; Contractor) By:------ .._..........•--- SteEkr ,F.aNf:---- - ------------ - -------- (True) .................................. -----------•-- (Plot plan, showing size of lot, location of system in relatio o wells, buildi s, etc., can be placed on reverse side): FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY -- ---- --- ---- ----------------------------------•---------•--- DATE-•---------••--•-- --- --... ----------. REVIEWEDBY ------•• •-----•-------------------------------------_- - ------ --- ---------- -------------•----------------------- DATE........................................................... BUILDINGPERMIT ISSUED-------------------------------------------------------------"- ------ DATE............................ -- •••----• -- Alterations and/or recommendations ----- --------------- ---- --------------------- •---- •---- _... - ---..: ..-._-•-- 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 Revised 1.57 F.P.CO.