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APPLICATION FOR SANITATION PEWIT Permit No. __ .�_ _�s .------- p� b; (Complete in Duplicate) Date Issued __ -1-si ----- Application is hereby made to the San - m l Health District for a permit to construct'and install the work herein described. This application is made in compliance o n-grd nce No. 549. JOB ADDRESS AND LOCATION = [- �'If _ ------ _ i----------------------- --- l+ -�� ---------------------------------- 1 ------------------------ Phone__;Z*9_t_54------------ Owner's Name ----- +�__s__c-+__-- :_ Address � 3----- �--t.... ..&, - -lo� ------ _q1 s --- --•-------------------•-------------------------------------------------------------------------- Contractor's Name------ - -- -- - Phone. Apartment Commercial ❑-" Trailer Court'❑ Motel ❑ Ot r ❑ _/ Installation will serve: living Numberofbedrooms v Number of baths ----�__ Lot size w___.. �-__.__ --• 01 Number a g . Wafer Supply: Public#system F1Commuriity system ❑ Private 1d Depth to Water Table "ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ElSandy Loam [;� Clay Loam ❑ Clay El Adordpan ❑ Previous Application Made: Yes E]No Rf New Constructio n: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATION: (No septic tank or' cesspool permitted if public) sewer is available within 200 feet.)F '� �' piston dation__.:_ 1p- �----.Mater al-- Septic, Tank: Distance from nearest weiL__� _ ____ No. of compartments --------3 -- ------------Size-- ------------ ----- ------Liquid depth-----4�------------Capacity - f + �- �•' t Disip po al Field: Distance fromraearest weli----$Q_ +i1 Distance from foundation _:LQ---�--bistance to nearest lot line___- _.'t____-- ,�, ------ -- Length of each line ------ e _- __-- Width of trench__--j------- Number of lines____________ _ g : ,11 Type of filter rrroferiai-__ d Depth -of filter matenai_____lf_ __--______.Total length____---- r� Seepage Pit: Distance to nearest wel------------------------ Distance from foundation ------------ .------- Distance to nearest lot line ---------- '_.__ W 4 -------Size: Diameter---- -------------- ---.De th------------ - --------------- T-1 ----------:- ❑ Number of pits ---------------------- Lining material-----"------ -- l 6 Cesspool: Distance from nearest well_________________Distance from foundation ------------------- Lining material____ -__.______---. �j ❑ Size: Diameter---- ------------------- - -----Depth- i -----•--------- ---- Liquid Capacity gals. T Priv Distance frern nearest well______________ ____ -- Distance from nearest buildin:;:._--..--_______-------------------- -- _ 9. A = =--------- --- Distance to nearest lot lire _-_______---- `_ i Remodeling and/or repairing (describe ------ -----•------------ ----------------------- --- ------------- S Z hti Vii _ t4` h t om' ----- ---- --- - C, t ------- ` -----i ' ••-At9------- -•------------ ------------ -- - ._----------- ----------------------- ------------------------ --------- } l L------ _'I� •-- -- I hereby certify t I have pYe -"ed this -applica ' and'that t ork will be ne in actor §vice with San Joaquin County ordinances, Stat aw an rules n regulati s of the San Joaquin Local Health District. f, 9 (Owner an. � -- -------------------- --- (Signed)- ,. , .n T tl -------------------- .�'---------------(i e)------------------------------------•--------------------------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT VSE ONLY - APPLICATION ACCEPTED BY_ _ DATE----------- -------- •------- ( `--,i--------------•----------- - REVIEWED BY ---------------------- BUILDING PERMIT ISSUED-------------------=-- ------ ----------------------------- ---------------------------------- DATE -------------------------------------------------- ----------- + Alter tons and/or reco endations•------------------ --- ---- ---------------------••------------ ----------------------------------------------•-------------------------- --- - --- - -- - -�-7-- ---- ------------- ------------------- ------------- ---------------- - - - - ---•---------------------- - " - - - _J -- -------------------------------------- ----- -- Sy FINAL INSPECTION BY:_____-- -- ------------ Date---_-.. !---------- - --------------"------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ti 132 Sycamore Street e14 North "C" Street !30 South American Street 300 West Oak Street Lodi, California Manteca, California Tracy, California Stockton, California ES -9-2M ,- Revised 1.57 F.P.CO.