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op�Y APPLICATION, FOR SANITATION PERMIT Permit No. __9 ___ tp1' (Complete in Duplicate) Date Issuedf/-.7/..-__. Application is hr .eby made to the San Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliance.with County Ordinance No,. 549. r JOB ADDRESS A LOCAT,ON--- a- C�--- - /� +�,- -- 4 _ -- -- { ---- - ------------------------- Owners Name---------------------------------- -•- •- •- ------------------------------------ -------------------- ----------------------------------- Phone---- •------------------------------ Address.,__- .._ __ ...--- ------------------------------ -------•-•------ ------------Phone--------------•------------•___. Contractor's Name____ __ ______________ - -- ------ -- --------------------------------------- ----------------- -------- _ f Installation will serve: ' Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Moi el Other ❑ -� F .Number of Living units: :;;�=nunify ber of bedrooms _Z:- Number of bathss--1_ _ Lot size __. _C __X____ ______---------------_________-- Water Supply: Public system system'❑ -Private'❑ Depth. to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ !Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe G3-___Hardpan ❑ Previous Application Made: Yes.❑m No ❑,_.,,,; New_Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION ANI),SPECIFICATIONS: 40, ' p No septic tank or'cess ool'' ermined if • ublic sewer is avafromle within 200 fe t , � P � P � p P g •) Septic Tank: Distance from nearest well�� r ��,��`" .Mate i?l__________ ________________ - -- -- � '� -nSize -- 1� `� =--Li Liquid ple fh--'-----ft'-- -------- Capacity- � � No, of compartments_ q R C _ ) Disposal Fiefd:m Distance from nearest ry II----_ " t 4Distance from foundation l Distance to nearest lot line__ _�_? , �,J/� [v� Number of lines----------- j_____ _-_._____ Length of each line___________ � _t,- :Width of trench_________ _ `T_r,�d Type of filter materig_ ___ D epth of filter materi --------I g , --------------- Seepage _-- l ------Total length---- Type Pit: Distance to .nearest w&f----------------------Distance'from foundation-------`---..'..--..Distance to nearest lot line______________._ ❑ ' Number of pits----------------------Lining material-----------------------Size: Diameter------------ --------Depth--------------------------------- Cesspool: ------------------------------ -Cesspool• Distance from nearest wel!---------------- ___Distance from foundation-------------_-----.Lining material____-__-____---_____-______-________ ❑ a Size: Diameter-------------------=----- ---------:-Depth-----------------------=- --------------------------Liquid Capacity..-.-:----------------------gals. Q Privy: A Distance from nearest well________-_-----------_°__________________________Distance from nearest building______-___---_---_______•--____---__---- X _ r Distance to nearest lot I'. --------------------------------------------------- ---•--•--------------------------------- „ Re obeli �and/or re 'airing {describe= ! --------- ------- --1----------------------- ----- ..............................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, ti and rules and regulaons of the San Joaquin Local Health District. (Signed)__4/ �'� r''e�_ ------- ------------------------------------•------------------------------ ---(Owner and/or Contractor) BY: = r -------------------- _--------------------------------------------------------(Title)---••----------------------------------------- --- •------------ (Plot plan, showing size of lot, location of system in..relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � �= = DATE�- _.� ------ ~~ REVIEWED BY ----------------------------- ------------------------- ----__ DATE---- . -- _ ---�----------------------- BiJILDING PERMIT ISSU�D__}___ _�_ _rDATE_ . - �---------------------------- - - Alterations and/or recommendations:_______________ -• �_____•_ L '�'f F , r ' ______________________________________________________ 1 r . .. --------------------------------------------------------- ------------------------------------------------------------------ -----------------------------------------------------------_ --------------------------------------------- ---------------------------------------------= ----- ---- ' is . FINAL INSPECTION BY---=---A- ---- � 'a__ Date---------------------------- ----------------- ---------------------------- .- SAN JOAQUIN LOCAL HEALTH DIS ICT 134 South American Street 300 West Oak Scree} 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ' ES-9-2M Revises 1-57 F.P.CO.