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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued �j �.0 � ppfica on is ereby ma a to he ;an 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. /71— JOB 7Q JOB ADDRESS AND LOCATION- _ � Ccs &7W Owner's Name_____.-__/j- ----------v /t1�is11 --------------- Phone Address-----------l - ------- -------•--- �----•--------•----------------------- ----------------------- --Contractor's -----------•-•--- Name---------- ---� c ij--------:�.---�-A_L------------- - Phone -Phone ---- Installation will serve: Residence ❑ Apartment House p Commercial ® Trailer Court ❑ Motel El Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths - „ _ Lot size ---f- A-_____ --------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table Y'6'-ft, Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑t Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes El No ❑ FHA/VA: Yes E] No E] [�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` O Septic Tank: Distance from nearest w6l___4:i7__-_-_Distance from foundation_1Q------ ---.Material___1�esf w Vic' f I No. of compartments------Ae--------. ---Size------- -�5_S'X-J---- Liquid depth----k--------------------Capacity--- Disposal Field: Distance from nearest well_., _ - Distance from foundation--IP--f-__-----_-Distance to nearest lot line- Number of lines- ------------ -'-. -__---------Length of each line--------- Width of trench-----,. -j<----`------------------ Type of filter material-__._ ___C- Depth of filter material__ {g' _---- Total length----_----_� -`___----------------- Seepage Pit: Distance to nearest well_----_---_--- . ----------------------Distance from foundation--------------------Distance to nearest lot line__-_-__.______.-_ ❑ 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 well_- ----------------------------Distance from nearest building--------------------------------- Distance to nearest lot line___________________________________ _ -------- Remodeling and/or repairing (describe):__--__ G'P .. --------------------- --•------------------------------------------------------------------------------------- ------------- ----------------------------------------------------------- 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 an , regulations of the San Joaquin Local Health District. (Signed) -> -----• --------------- / ( `n Owner and/or Contractor) `V By-------------------------- ------------•----- : ---------------------------------------------------------------------------------(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 REVIEWED BY - ll kr�r,,_ -- -------------------........................ ------ ' ...----- DATE - ---------, APPLICATION ACCEPTED BY--------------------------- _- DATE----__ --- L ING PERMIT ISSUED---------------------------------- -------------------------------------------------------------- DATE---- ---------------------- --- ------- ------------------- Alterations and/or recommendations___________________ ..__ _.�_____.______ -------------- ---• ---------------------------------------------------------------------------•---- z.;µ -- - -- ------------------------- v ---------------- -------------- -- �." --------------- - l-------Ecf p 'l` ------`---- -c .r..� f- - - ------ -- ---- ----- FINAL INSPEC Date---------- + ---------------------------- SAN JO IN LOCAL HEALTH DISTRICT 130 South Ameriea rest 300 W est Oak 5tr•• 132 ca 5 more_$treet Stock+on, Californiay $14 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F-P.CO.