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APPLICATION FOR SANITATION PERM1T Permit No. qQ_---- ---- (Complete in Duplicate) Date Issued ---------- ------ Application is hereby made to the San Joaquin Local Health District for a permi o cons uct a�,n¢¢I� �nsta the work herein described. This application is made in compliance with County Ordinance No. 549. aC� JOB ADDRESS AND CATION �n -- ------ Owner's Name------------ ----------------------------------- ------ ------ --------- = ------------------------- --------------=----------------------- Phone---------------•-------------------- 1 F\ Address -: ` <Q -------------------- --- r`^------------- ------------ - ------------ �� ` Contractor's Name = - � `"' --------- ` + Phone - -•- ------------------------ Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court [:] Motel ❑ Other E] Number of living units: __ __ Number of bedrooms __ Number of baths ___ Lot size _..___ ~ . ----- •--- -3- - - Water Supply: Pub#ic system ❑ Community system Private ❑ Depth to Water Table -------- ft: Character of soil to a depth of 3 feet: and E] Gravel El Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan E] Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ .. , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ' tic..,Tfr::' Distance from nearest well_________________Distance from foundation--------------------Material_______-______--____-_ --_________-._.-.__---_. No. of compartments--------------------------Size-------------------------------Liquid depth---------------- ---------Capacity----•-- ===------- o j �jr 1 posal.Field: Distance from neares# welkr . ._ _.Distance from founds#iofi- __ Distance to nearest lot line __. Number of lines_______ ___,.- /�-___Length of each line_Z__-_- --- -----------Width of trench---- ---- -- Typed� Type of filter materDepth of filter ma#erial__ti -------Total length- ____ Q_Qf_______ '_____. ___ i pag P : Distance to nearest wef€______ om_______________Distance frfo eeitundation-------------------.Distance to nearest lot line----------------- Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---- ------.--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------......Lining material-_____.---___-______-___-___________- F1 Size: Diameter-------- -------------------- ----------Depth---------------- ---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------------....Distance from nearest building------------------------------------------ . .„ - Distance to nearest lot line______________ w _. _._,_------ RemodRemodeling eling and/or repairing (describe):----- --------------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. DAY& laCT - „ (Signed)------ •-- _ � -----• --- - - - --- -----------------�-------- i /1 - rrd/ror Contractor) Septic<766-k ervs�e � f,/_ j � / By: 246_SQ t1dorado---E ?7£#ri� (Title)-- °�"" _, t)A44 ------------------ (Plot plan, showin Ize of lot, locA16fi1bbrtyffaiffin relation to wells, buildings, etc., can be paced on reverse sid 1 i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----------------------------------------------------------------- DATE__ - ----------- REVIEWED BY---------------------- ------------------ 1 -------------------------------------------- DATE----------- BUILDINGPERMIT ISSUED----------- ------------------------------------------------------------------------------------- DATE_------------------------------------------------------------ Alterations and/or ., recom_mendations----------------------------------------------------------------------------------=---------------•-----------------------•----------------•, ------------------- __:__ _:_ _:__ _ =___ ` ___ _ _ _ _ __ce _i __ _ _ �- - f FINAL INSPECT BY:----- Date----------------------- ----- ---------- *'�° '� JddQi i 'LOCAL'H ALT DI TRf T 130 South American Street 300 West Oak Street [32 Sycamore Stre r$i4' Stockton, Califdrnia nr Lodi, California Manteca, Calif rr a /— T.ecy, Califo�r 'aa ES-9-2M Revis d 1-57 F.P,CO_ "`r�' .