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APPLICATION FOR SANITATION PERMIT Permit No. 9C1_ _-q (Complete in Duplicate) -- -- Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work h�i d Tsc eb d This.application is.made inIcompliance.with County Ordinance No. 549. Vt6,6:4 t.�J . CWvr .d . � JOB ADDRESS.AN ON_LOCAT ____ Owner's Name___ ------ IA � - 41 P �Address------ -0--f------- . ------- a ----------- -------------- -- --- Contractor's Name----------j ` --------- ....Phone----Installation will serve: Residence ❑ A rtment House ❑ Commercial a' curt ❑ Motel ❑ Oth r Number of living units: "�_Number.of bedrooms k�' Number of q _ Lot size _�_ d_"" Water Supply: Public syst' m ❑ Co:10mmunity system ❑ Private Depth to Water Table :6--- ft:- X e k-t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan ❑ Previous Application Maden Yes ❑ Nd New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION�IAND SPECIFICATIONS: (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_" _p_""D� . 4b Distance from oundat _ Ma eril_ - - No. .of compartments- . 1_,_�Liquid de1?th_____�' '' Size ----Capacity.... Di oral Field: Distance from nearest well_.. __ a_ Distance from foundation- r J-0 to nearest lot Ii e-167) ------------ Numbe�,of lines__:__"----- Length of each line_--___ j' - r f-Width of trench ____ _.___ Type of,filter materiaL___ Y �+- Depth of filter material-_------- Total length__.....&---_-_"-----" Seepage Pit: Distance to nearest well-------------------------Distance from'foundation_._____..__-__------Distance to nearest lot line____.__."- ❑ Number of pits---------------------JUning material--------------- -------Size: Diameter-----------------------.Depth-------------------------------- 0 Cesspool: Distance from nearest well_________________Distance from foundation _______------- --.Lining material--------- F1 l-_____._.❑ Size: D1 meter ____,_.____,.___-_.__—___________— __.. Depth ------ - -- ------Liquid Capacity__ gals PrivY= Distance from nearest 0 vrelL __--_-""_-__- -- _ -Distance from "nearest building 9------------------------------ ❑ Distanceto nearest lot line : --__"-_--""" --- _-< _ —= ..-- Remodeling and/or----r-e----p--- epairing (describe):------ ---------- k -----------------------------•-- ------------------•-------- ------ ---- -------- llh -------------------------------------------------------------------------------------------------- ------- -------------------------------------4-------------= - . - -� = ------------ ---------------- L--------------------------------••------ ------------------------ I hereby certify that-IHave prepared this application and that the work will be done in accordance with San Joaquin Countyr ordinances, State la s' and "Wes and regulations of tl�e San Joaquin Lo a`1 ealth District. x _-"-- (Signed } --- ---- is --------------- caner and/or Contractor) BY ----------- , -- -------------(Title)--------- __________ (Plot plan, showing size a lot, location of system in.relation to wells, buildings, etc., can be r placed on-reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______________ ------------------------- ---------------------- DATE -------- ---. - -------- REVIEWED BY ��'------ r DATE BUILDING PERMIT ISSUED--------- - --•-------------------- �------------------------ -------- -?,—:, � --- --------- DATE---------- f --- - Alterations and/or recommendations: . " ---------- =---- --------------- ---- ----- -------------- ---- - ---- --------------------------------------------•------•----------- --------------- -----------------------.---_---- --- ------_--------------- FINAL INSPECTION BY.".______-___ - ------- -- ------------ Date--------. � ' I ------ 111 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California Lodi, California 132 Sycamore Street E14 Horth "C Street Manteca, California Tracy, California ES-9-2M RBv1560 1-57 F'.'P.CO. il[ 1