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APPLICATION FOR SANITATION PERMIT Permit No. .-,7--- ---T_-U- (Complete in Duplicate) Date issued p Applica+ion is her made to the San Joaquin Local Health District for a permit to construct an instal t work herein ciscram i�beld. This application is made in !mpliance with County Ordinance No. 549, / pp , JOB ADDRESS AND LOCATION_ __ __ ac _______________ Owner's Name------- ----..:. = -"` a- -----------j -- -------------- ------------------• -- Phone.--------------------- Address---------------L ---------- ........ . -- - - --- -- --------- - �-- ------ -------------------------- -------------•---- -------.............. Contractor's Name-- .�_' .. s ------- --� "-------�"<`-.-----•r--0--------------------- Phone----.------ 0.t Installation will serve: Residence �A'�arttmment House Commercial Trailer Court El Motet Other Number of living units: _-1--- Number of bedrooms_.- Number of aths .- Lot size ------ _-. t _ - ------------------- Water Supply: Public system [ICommunity system ❑ Private Depth to Water Table .-_.___- ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] Clay El Adobe ❑ Hardpan ❑ Previous Application Made: Yes El No [ New Construction: Yes DeNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if puis sew r is available within 200 feet.) ` Septic Tan Distance from nearest well_�_. __ __Distance from, �► faundation__I©-.._-._.Material__________________ _________ -- No. of compartments----_ ---------------Siz � � Liquid d4epth----- '� _ _.'..-- .Capacity_.�� Disposal Field: Distance from nearest well----A�PrDistanc�rom founn 40- to nearest lot line----- -- ..... Number of lines-----Z------------------------Length of each line-_'_( ------.-.Width of trench.—Z-4-If------------------ Type of filter materia l-� `_E,.....Depth of filter material.-.[49------------Total length-----/..-&__01� .r------------------ Seepage Pit: Distance to nearest well____-.----------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth.......-------------------_--__-- Cesspool: Distance from nearest well-----------------Distance from foundation------._----------_.- Lining material-------------------._-__.---__-_--_--. t ❑ Size: Diameter--- ------------------ -- ----------Depth------ ------------------------------------- ------Liquid Capacity---------------------------gals. I, t Privy: Distance from nearest well_.-- ---------=--------------------_....____._-..Distance from nearest building.._.______.__.__________--__---_---_-._. ❑ Distance to nearest lot line--- ------------------------------------- ------------------------------------------•---------------------------------------------- s r Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------- -•------- ----------------------------------•--....._--- I ----------------------------------•--------------------------------------------------------------------•------ ---•-----------..-..-.._..-.----------------------------------------------------------------------------------- ------------------------------------ ------•--------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------- -• ISN -----------------------------------------------------•-----------------------•----------------------------------------------------------------------------------------------------••----------------------------- 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, and rules and regulations of the San Joaquin Local Health District. 99 DAY& NIGHT (Signed) i -----_ r Contractor) , --------------Septic�TrsnTi Service r' T gY: 12Qb_ Q Rdarmclo A�-704 ------ ----- -------- ;p _(Title} - (Plot plan, showing size of lot. WSM"ai 99ifem in relation wells, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY - -- -- --- DATE 4 .� -------------------- REVIEWED BY------------------------------------- ------- -------------- -- ---------- DATE ----------- ---------------------- BUILDING PERMIT ISSUED------------•----------------------------- - ------------------- -- -- DATE Alterations and/or recommendations:---------------------------------------------------------------------------.---------------------------------------- ---•------------------------------•---•--- ------------ ----------------------------'----------------------------------------------------------------------------------------------"-"------------------------------------------------------•-------------------------------------- G ------------------------------------------- ------ ----`-- -------- -- ------------------------------------------------------------------------------------------------------------------------------------- k ----------------------------------_.-__-...---..-.__---...__-_-_------_.-.__-_.---..._____.--.--.._------._.-._----_.-_--_..-_.__._-__-_-..-__-._--._.._-.-------._-.----_-_..-_---__._-_-_--___._--_____-______---___--._- FINAL INSPECTION BY:. i Dste__....f _ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore $frost 814 North "C" Street k Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M I.-I.ATWCIO" 12 54