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APPLICATION FOR SANITATION PERMIT Permit No. .-93.9_-... (Complete in Duplicate) �/ / „: Date Issued _1 .4 .9 Application is hereby made to the San Joaquin Local 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 LOCATION--_._`7__ ------------------------- --------------------------------- --------- Owner's Name____ -_ = ` - --.r--- - ----- r ---�------------• -----•------------ _ - -- - ------ ----------------•-- ---------- -- Phone Address-------•---- eGC ------- Contractor's Name-_- ------------------------------ ------------ ----------------------•-------•----- -- Phone Installation will serve: Residence Ej Apartment House ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms --- Number of baths -_ _ Lot size Wafer Sul : Publics stem APY y Community system ❑ Private Depth to Water Table SAft, r Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ "Clay Loam Ar�ay ❑ Adobe❑ Hardpan El �! Previous Application Made: Yes ❑j No �� New Construction: Yes ❑ No R?—FH/A/VA:.Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sep Tank: Distance from nearest well---- -------------Distance from foundation------------------- Material -----------. No. of compartments--- -__ Size--------------------------------Liquid depth_-.______..-__-_____--__--Capacity_.---------.- ----------------------- Disp Field: Distance from nearest well---_-�_____Distance from foundation____________________ Distance to nearest lot line_--___--.-__---- Number of lines--------f-----_ �----j--�-_------- Length of each line------�---------------.Width of french.-------�:>----- -- / Type of filter material-_f'/ / ---- --- '�epth of filter material_--1�_l__-__--Total 'length-------k -__--------_ $�e aage�yPit: � Distance to nearest well___-__"' ------Distance from four ation--�� Distance to nearest lot --_---_-: P J ! Number of pits__-.--1-----__4__Lining material _ __- -- - __ ize: Diameter- --'` Depth r _�—- ,. - --------------- ess oo : Distance from nearest well------------------Distance from foundation--------------------Lining material-----------.--_.----------_---_._--- ❑ Size: Diameter--------------------------------------Dept h-------_ ------------------------ --------------Liquid Capacity. -------------------------gals. Privy: Distance from nearest we11---- ---------------------------------------------Distance from nearest building ❑ .Distance to nearest lot line " ------- Remodeling and/or repairing (describe)---------------- " - -------------- l -------------•----------- I -- ----------------- ---------------=----------------•----------------._ ------------------------------------------=-------------------------------------------- -------------------------------------------------------------------------------------------•----•-- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of f e San Joaqui Local Healfh District. [Si ned '/ g )------------- -- --- --- -------- p� i - r Contractor) BY [Title) --------------------------------------------------- 'x - (Plot plan, showing.size of lof,.locat' of system in.relafion fo wells, buildings,-efc., can be placed on rever side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED. BY-------.__ . _ REVIEWED BY _ DATE. _ ------ ------ ----------- ---------=----------------------------- DATE--- ,r" BUILDING PERMIT ISSUED------------------- --------- lll -------=---. DATE. ----------- Alterations and/or.recommendations---------------- -------------------- ----------------------- ----- --------------------------------------------------- - FINAL INSPECTION BY:-.--- ' Date SAN OAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street x132 Sycamore Street 814 North "C" Street I Stockton, California F Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.