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(. �y .�-`�- 4 •� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued L;k al Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loc This application is made in compliance with County Ordinance No. 549. :- �--------------------- --------"I-------------------------------------------- JOB ADDRESS AND LOCATION._Owner's Name------------------------ ----------------- -------- ---- ---------------- -------------------------- Phone-------------------------•--------- ---------•------------------------------------------ ---------•--••-----------•---------- Address. Phone Contractor's Name---------•---------------�------p-------------------- -- ---------------------------------------- -------" .- — Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai4er Cour# otel ❑ Other . s t Number of livingunits: _ -. Num er of bedrooms .------- Number of baths -------- Lot size .---___ _ --------- Private ❑ Depth to Water Table ___-__. ft. Water Supply: Public system ommunity system ❑ an Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam El Clay ❑ Adobe�H andp- ❑` iR Previous Application Made: Yes El No ��e, Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank r--cesspo permit edpubii c �eravailablew;�hi,c ?aQ feet.) r •_ r Septic Tank: -,stance 4501 nearest D'stanm foundation �4 _ Liquid_, depth------M---a- er"ia--l-_-_-_w--.-_-.-_-'-Capacity---- A l& __<_ t No. of compartments---- Size---- ` Distance to nearest lot Iine:Y� Disposal Field: Distance from nearest well_-""_ -__.-Distance from foundation_.-"_ - �" "Width of trench________ .�r------------- Length of each line______" �r Number of lines g �. �ee,; of Type of filter material---�f �'� - -Depth of filter material___ _`"_T_""--•--Total length----•--- - -- Seepage Pit: Distance to nearest well___-_----.__-_.---_Distance from foundation-Size: Diameter-----------------------Dsstance to nearest lot ine=^^------==------ ❑ Number of pits-------- ----- ---- -Lining material--- ------------------ ing Cess ool_. Distance from;nearest well-----------------Distance from foundation--------------------�inuid'_Cat material --------gals,. P; _. .. —D _P -7 r _� .may - Size: Diameter----•---- ------ ---- - .......Depth"-- ------- --- -----• ---- -- -- -- ----Liquid- P -- ---�--------•�•--- ❑ -------------------Distance from nearest building-------------------------------- Privy: Distance from nearest well._______---------------.--- - ( ❑ Distance to nearest lot line-------------------------- ---- --------"---------•-"----- ---------------------------- -------------------------------------- -----•--------------------------------------•-----------------•---------------• . Remodeling and/or repairing (descr-iibe)-----------------"------------ ----------- - ---------------------------------------------------------------------------------------------------------------------- ----------- ---------------- - --------------------------------- ---- --- - ---I -------- - - -- ---- ---------- her ° I here- • -- by certiti -- fy that I have prepared this application and that the work will be done-in accordance with an Joaquin County ordinances, State laws. and rules and regulations of the San Joaquin Local Health District. � ,�/'�/� �Jl��-�'. �!°�.�--------- --------- - ------- -------- ---------- ------ caner and/or Contract (O d/o or) ( 9 )---- ----------- --- Title g ------------------------------------------------------------------------- ---------------------------------------- y ------------ ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). SFO DEPARTMENT USE ONLY DATE j, {� APPLICATION ACCEPTED BY"------------� -=----- DATE REVIEWED BY ------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------------------ - DATE Alterations and/or recomme ations:___ ___ """,-.-------------------- ---- ---- -- --- ------------------------------•------:-------------------------------- 2'` '$ Z- ---------- ---- - ----------------------------------------------------- __ -------------------------------------- ------- - -------------------------- - FINAL INSPECTION BY: '12 Date-------------- ��::- ---- ------- �� SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 NorA "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9-2M B-51 Revised W-2100