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J APPLICATION FOR 'SANITATION PERMIT Permit No. --- -----`-<----•- (Complete in Duplicate) Date Issued ___ - S� Application is hereby made to the SanJoaquinLocal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N 549. JOB ADDRESS AND O ATION �/ = ----'•---_----- f 1 r IQ Phone_ ---------------------------------------- ----------Owner s Name - - -----•----------- Address----------------------------------------- -----------------'------------------------------------------------•- ...., { .1 o-: r Phone------_---------------- ------ --------• --------- installation will server Residence �° p,pe tm ---erci- ---- Contractors Name________________ __ - - ent'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + r . 'T-4-- ' � � Number'of Living units: __._.___ Number of bedrooms ____3 Number of baths"__.__� Lot size __f--- ----- ---I& Water Supply. Public system;K Community system ❑ Private :❑ Depth to Water Table -------- ft: t f Character of soil to a depth of 3 feet: Sand E] .Gravel F-1SandyLoam ElClay Loam [I Clay C] Adobe Hardpan [I Previous Application Made-, Yes.[:] .NoX New Construction: Yes ❑ No ❑ FHP/VA: Yes ❑ o ❑ w � A TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) /1 - -— - �q D Septic Tank: Distance from nearest well------_ -- (__Distance from foundation__- -------------Mrial___1 � ---------------Size--- , Liquid depth__.__-- -_-_-.----- --:Ca acit Y-- a- No. of compartments_.__ Disposal Field: Distance from nearest well_ _ Distance from foundation-___a2_6____ Distance to nearest lot line__. lines------ _ - ------Length of each line__-- --, _--- --r-width of french------- -- a ------------------- Number'-of, i Type of filter material-_ . Depth of filter material-__-/_ --------------Total length__ --------------------------- D ' ---- ----------------- iL....:,.... ,.N. "_ Seepage Pit: Distance to nearest well_'-.- :__- __- _C}istanee from foundation -..Distance to nearest lot line_________________ ❑ Number of pits----------=-- LinEng material--------- ------------ Size: Diameter Depth Cesspool: Distance from nearest well--------------- Distance from' foundation___--___-----_---.Lining material-------------------------------------. Size: Diameter------------------- --------- Depth-------------------------- ---------------------Liquid .Capacity--------------------- -- -gals: r ❑ t --------------------Distance from nearest building------------------------------------------ ---------- Distance r - ---- Distance from nearest we ❑ ------- 9Y Distance'to-nearest lot line-:-:_-_^�'^-^r"---- = -----•-----------------•-------=----•--I---------------------- Remodeling and/or repairing (describe)--- -------- ------------g--------- ------- ----- . t ------•------------------------------•------------------------------1--=-----=----....---------------------------- - ---------- , --- ------------------ hereb certify that I have r y y p epared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r les re lations f the nnJoaquin Local Health District. i Si ned `---------- caner an r Contrac# (O d/o or) r ( 9 } € = ---- ------- ----- (Title} Y----_------ - -------------------- (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 ° APPLICATION ACCEPTED BY------ ------- 4 DATE f t REVIEWED BY-------------------------------- DATE---- "'' p ----------- ------- BUILDING PERMIT ISSUED ---- ---- - �,r ATE �„`_..- _ ------------_-------- Al ti s a ,f r e mmendati ps:-------- ° ! = off - -_:_-_--- ........ - - -- ---- -------------------------------------- ----------------- ---------------------------------- ------------ ---- k • �. ` _ . FINALINSPECTION BY:_-- _ ___-`. --:=- --• -- ------------------------------------ -Date-----�------- --------- •----== ' SAN;J A¢IJIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California _ y- ES-9-2M . Revised 1.57 FYCO.