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APPLICATION I OR SANITATION PERMIT Permit No. (Complete in Duplicate) #�.ZfLr-kta1�4 y ac r Date issued Application is hereby made to the, Sc Jbaquin Local Health District {or a permit to construead install the work herein described. � -OWE This application is made in-compliance with County Ordinance No. 549. n JOB ADDRESS ANq� �N ATION___ A z._... _JOC .._ Owner's Name --- --- -------------- a,-e- ------- -------------------- - ---- Address w Phone_ __ -9_�S'� -- ---- Contractor's Name f _.�------------------•----- __ -----�--- Ins+alla+ion will serve:7Residenee'�',e,partment House "" Phone.CQ B" ❑ Commercial ❑ Trailer Co`urt'❑-'Molal"® Other ❑ Number o{ living units: _ _- Number of bedrooms l Water Supply: Publics stem I ____ Number of baths -_�f___ Lot size ______ _ _ I Y ❑ `Commun'ity system. Private ; ---"_____________"" k �bepth to Water Table •.`_O ft. Character of soi! #o a de th of 3 fee+: Sand " y P + ravel ❑ 5andy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] ❑ ILS•--New Construction: Yes ❑ No i TYPE.OF INSTALLATION AND SPECIFICATIONS: i ©�FHA/VA: Yes ❑ No �- (No septic tank or'cesspool permi}ted if public sewer is available within 200 fee+.) �,. . . }�ti Tank: Distance from nearest well------------------Distance from foundation___•_______________.Material____."_____--__. No. of compartments ------------------------------ *y'f. i Size__r. '-----------------=---Liquid depth_.-------------- -----#-Capacity---------------------- Dis osa! Field: Distance from nearest well-------------- f Number of lines__:_ _4" f Distance from foundation___.___-____1__-__Distance to nearest lot line________"__"_ I a p L: } ---- ------- - ----- - --Length of{each line-----------------------------Width of trench.-------------------- Type of filter -j------------------------- -_ "_-Depth of filter material______________"--------Tota! length___.___-___-_____ Seepage Pit: Distance to ne'arest�well f --_Distan rom undation3 t Number of hs__._ •---.Distan Distance to nearest 1• e S`f p -------------Lininglimaterial -- -- --..Size: Diameter------- Depth_ o Cess ool: � ❑p Distance from nearest well________---...Distance ?rom foundation--- materia!_.-_- ,. .,T Sipe: Diameter + ----- Depth-------- -. , a Liquid Capacity--- -------------------gals. Privy? Distance from nearest well ___---_-" _"___-"_"__Y" � pistance fromnearest buildin „mss-.� � �. - Distance to nearest lot line------------------- g=------------- ---"�-�-•--------_----. N --------------- ------------- -----------------------------w --------- Remodeling and/or repairing (describe)=----------------------------------------------------- =� ------ -------------- ' - ---------------------------- ----------------------------- ------- -----------•------------------------ I hereby certify that I have prepared this applies+ion and that the work will be done in accordance with San Joaquin County ordinances, S# a laws, and rules aZrla+ions of the San Joaquin Local Health District. w (Signed)------ -- --- ------------ -- --------- ------------------------------ .---(Owner and/or Contr (Plot plan, showing sizactor) -- ----------Irtle)-----��"�]' e of lot, location of system in.rela+ion wells, buildings, a+c., can be placed on reverse side-- (' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ___ REVIEWED BY-------------------------- `Z. $. `� ------------------------------------------------- DATE-- -- - BUILDING PERMIT ISSUED-------------' - BATE-----A ___ Alterations and/or recommendations:__ ______-_"_-_""-_ "_ . DATE.__.______. ----------------------- ------------•------------------------ ----------------------------------------------------------------- i --------•----------- -------- N14 -------------- FINAL INSPECTION BY._ ._-_ ) Date_.. `- _ . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C'• $tree} Stockton, California Lodi, California Manteca, California Traey, California ES-9--2M . Revisecl 1-57 F.P,CO.