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PPLiCATION FOR SANITATION PERMIT Permit No.1013.0------ + ` UkEt�i (Complete in Duplicate) {� Date Issued re m Application is heade 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. KW q � .- JOB ADDRESS ND LOCAT ON.--- -----------_l-�-------- ----W- -c- Owner's Name--------------------- ----- ---- - - • ---------- ------ ---- - �f ` -------------- ----- Phon-e- ---------------------------------- -------------- ------- - ------ - Address-----•----- -----•------------••------------------------ --- -- ------ -- ----------- .�^ --- ------------------------------------- Contractor's Nam1�---- -�- - Phone----------------------------------- Installati will sery al esidence 9�/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z-_ Number of bedrooms -------- Number of baths Lot size _-_-:-�5---. �1I _�_-_ ----------------------- - k Water Supply: Public system ❑ Community system ❑ Private [g--'bepth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ErVo ❑ FHA/VA. Yes ❑ No [L}_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ti ` 00 Septic Tank: Distance from nearest well--S-r____Distance fromdation__10-----------Material----� __(�----------------- No. of compartments �-.----[------Size- �4°14-[-------- --__Liquid de th-----_-_�_ ---------------Capacity � {�------- Disposa i- Field: Distance from nearest well-~�_-_---_.-Distance from foundation---l-0---.--.---_.Distance to nearest lot line---S--_-----_-. Number of lines_-_------�2- __._+_ -- -------- _ ___Length of each line -_--hZ--___ti--------.Width of french----Zai-[[---. Type of filter material=- -.-- -- -----Depth of filter material---__19------------Total length_----_-:�0- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------.-..Distance to nearest lot line----------------- ElNumber 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)-------- ---------------------------------------------------------------------------------------------------------------- V ------------------------------------------------------------------------ ----------------------- �. 4. --- C ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ I hereby certif that I have prepared this applicatio nd that the work will be done in accordance with San Joaquin County ordinances. Stat I .s, and rules jW regulations of th n Joaquin Locai ealth District. i ----- -- (Owner and/or Contractor) Si ned By---------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). ' k FOR DEPARTMENT USE ONLY APPLICATION-ACCEPtED BY-- '['�'C, � ------------------------------------------- DATE--------- 1 =i --------------- REVIEWED BY---------------------------- ----------------- ---------------------=----------------------------------------------- --------- DATE BUILDINGPERMIT ISS_UED---------------------------------------=-----------------------_-------------------------------------- DATE--------- -------------------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------••------------- -------•------------------------- ------------------ --------------------- ---------------------------- ------------------------- ---------------------------------------------------------------------- -------- ---- - -- ------ ---------- ---------- -------- --------------------------------------------------------------•---------- -----------------------•---------------------------------------- 'K FINAL INSPECTION BY:- td k Date-...-. . 4 -- - `^""- �Yf � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soutfi +4Fnericen freet - 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1$w•. Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1-57 F.P.CO.AvcAni tk