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j6i APPLICATION FOR SANITATION PERMIT Permit No. __ .7 (Complete in Duplicate) 4- ------ Date Issued /Z".�. Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein d"escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_.!___--_-"'y_-"_�? Goe.ra Owner's Name---------------- -=-44_.'--�--- I}'�'' .--------------------------------- Phone__ "- s 7 '� Address ' ' -•7---•L'-- ++- ---------- on ractor s Name-----�--------------•--- ------------------••--- ' Phone------------------•---------------- ins+alla+ion will serve: Residence [�'' A artment House ❑ Commercial / ' ❑ Motel ❑ Other Number of living units: _ _ ❑ Trailer Court g ___ Number of bedrooms Number of baths _I___ Lot size ----- Wafer Supply: Public system Commurii#y system p ------------------------"--_-_ Private ❑ Depth to Water Table"g.0^ff. Character of soil to a depth or3fee': "Sand ❑ Gravel ❑ Sandy Loam Previous Application Made: Yes ❑ Clay Loam [] Clay ❑ Adobe� Hardpan ❑ #No ❑ New Construction: Yes ❑- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank`or cesspool permitted if public sewer is available within 200 feet.) ' Septic T n� Distance from nearest well-----------------Distance from foundation----•----- .. � -•------.Material----------------------------------- Size No. of compartments-- -- ------ ------ --- -------• --- ----------•- fLiquid depth Capacity--------- L j---- Disposal Field: Distance from nearest well_30----._ � 7NumbDistance from foundation___ -- ...Dish anee"to nearest lot�► toc,fp - _ _- _-- -- f, lin� er of lines------- -----.Length,of each line_ h F -"YPe of filter mateFial_ s- "Dephof filter materiaf__`EWrdthof #rancV__ oaength_------- L _ Seepage Pit: _ Distance to nearest well____`'___::__-_-"-_Distance from foundation______________ r ----.Distance to nearest lot line_________________ ❑ ► Dumber of pits-----;----------------Lining Material----------------------- Size: Diameter_ Dept --------------- Distance [� Cesspool: fi�om nearest well_____._______ _ Distance from foundation-------------------- ' ❑ Size: Diameter------'----------_-"_- Lining material----------------- --------------Depth--------------------- -------------------------- Liquid Capacity Distance fgals, Privy: rom nearest,.well------------ ------"--- El __-Distance from`"nearest Eiuildin ------------ = V = istance to nearest lot line-- --- --- -------- - ----- - 9----------------------------------------- - --------------------•-------------------------------------------- Remodeling and/or repairing (describe):----�� "- _q/ 411r ___" :/""__ qD f ------------•----•-----------••------••--•---•--------------------L •----------------------- - ----------------- ---•---•.--•---------------------------------------------------------- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin Co ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. q County' (Signed)------ - _ ' .� --------------------- ------- ------- ------- ------- --------------"--(Owner and/or Contractor) (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can{beeplaced on reverse side). I ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ____ 1r - �'--- -•-- ------ DATE-----�----�-----�- ------ REVIEWED BY------------------------------ - ------------•--- --- ----._ - ----------------- :; ---------------------- DATE-------•------------ , ----------------- BUILDING PERMIT ISSUED i - ----- -------------- �"-- ---------------------- A tare+ions and/or recommends+ions:__..______--"_--""-__" ------------------------------------------------------------ DATE -------------------- -------- --------- __ __-E_________________________________ 4 ------- ------------ --- -------------------------------- - --------------------------------------------------------------- ----------------------------------------------- -•---------------------------------------- ----------------------------------------------------------------------------------------------------- .FINAL --- - .FINAL INSPECTION BY:.. ff--� ff . Date--------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT y 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M r0-52 Revised W-2100