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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) pate Issued ----------- A __.//r°.-- Applica ion is hereby made to the San Joaquin Local Health District for a permit to construct and ins al[thew rk herein described. i�, This appllcatiort is made.in com fiance wit ounty Ordinance No. 549. nsta e, «.. _ .-- ADDRESS AND LOCATIO�__� ---- .-1 Owner's Name_ _. ,. - ------- _ Address- ----------- �� one -._...._ *_-----------•_Y__=_YlT ___ ______ _____________•a..____ ._..__.._-_...-______...___.__ F Contractor's Name----- .twe, _ --------- �n ---------------- Phone --------•-•--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial 4 Trailer Court F] Motel El Other El Number of living units: -------- Number of bedrooms -------- Number of baths --;4*- Lot size _ -� °-17A e-_E u"- Water Supply: Public system ❑ Community system [] Private Depth to Water Tablel_7o ft. j Character of soil to a depth of 3 feet: a Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan,[, Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material_-__.__._____..__.___________...____.__ _ ❑ No. of compartments- tt Size Liquid de,th- � Capacity Disposal Vield: Distance from nearest well-_--1.�----Distance from foundation___ p__--_-_--Distance to nearest lot line---- ----------- Cn, rr1d Number .of .lines--------------- ---------- ------Length of each line----- -,• -----------Width of french......�'--`-------------------- Type of filter material___----Depth of filter material---.._ ____Total length_____g, h__r----------------------. Z ,. Seepa .i Distance ao nearest well----�-0`-----Distance from foundation_-_ _ . .__..Distance to nearest lot line---. Number. of pits------- _._____-Lining material__ .-.Size.- Diameter-----r(a"----____.Depth__._, Cesspoo : Distance from nearest well----------------Distance from foundation--------- ---------.Lining material-----------------------A/4—.0 -- ❑ Sizer diameter-------------------------------------Depth--------------------•-------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------- _____.__ ❑ Distance to nearest lot line._.-__._______._--_--. - ��,��IPl;nn�and/ter repairing (describe)------------------------ t ------------------------- -----------------------------------------------------------•-----------------------------....------------------------------------------------------•---------------------.•------------------------ ---------- ------- ------------------•--------------------•-----------------------------...--------------------.--•----------.----.--------.----.---:------------------•-------------------------------------------- I hereby certify that-1 have-prepared this application and that the work will beAcine in accordance with San Joaquin Countyf ordinances, State laws, and rules and regulations of the San J quin Local Health District.- l c (Signed)---- ---- E - - - ------------------- an /or Contractor) e - V Y• ---•---_ '- � ' r ----------------------------------------- - ---------------- (Plot plan, showing size of lot, location of system in rela�Fioon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _ -----------------•------------_-- _-- DAT ------- ------ E---- - W REV ! ED BY - DATE --------------------•-- BUILDINGPERMIT ISSUED----------------------- -------------------------------------------------------------•-•-•------- DATE---------------------- Alterations and/or recommendations------------------------------------------------ -----------•------------------------ .. ::> :.. -•------------•--------------------•----------------•-----------------------------------------------------------------------------------------------•-----••---------••- --------------------- ----------------•-•----------- ----------------- -------------•-------------------------------------------------------- -------------------------------------------------------------•-----•--------------------------------------------- ----------------------------- -----------------------I --•----------------------------------------------------------------------------------•----------- FINAL—INSPECTION BY --- �--- - "E -----------------•----: Da+e.- - .4 ----•--------------------------------- ----------- ,"SAN ---------USAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California L d, California Manteca, California Tracy, California ES-9-2M Revised W-2100