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Permit No.a-A--A--- ' APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) •� - ��--� Date Issued_-_/-------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described- This application is made in compliance with County Ordinance No. 549. ------------- JOS ADDRESS AND LOCATION__.__ -- -- ` ' .. Phone-------- - _-- ------------------------------------ Owner's Name----------- /-•- � Address---------------- - --------- - -- lr h Contractor's Name--_ ��C _4}--- -- ---`--- -- -a� '`�1 �1 'r"� ------ Pone -Installation will serve: Residence [I Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: _ _ mber of bedrooms _ Number:of baths O-- Lot size ___- ------------------- Water Supply: Public:system. ,,,.Comrnuniiy—system.�0�rivate9g—Depth to..Water Table :____--_ ft. t la Loam Clay Adobe Hardpan ❑ Character of soil to a;depth of 3 feet: Sand �a�l ❑ Sand Loam ❑ y r ❑ Y ❑ t Previous Application Made: Yes [DNo New Construction: Yes No�❑ .. TYPE OF, INSTALLATION AND SPECIFICATIONS: v ' (No septic tani or cesspool Lrmitted if ublic sewer is avaiMI—p—m in.,,2aa fe.t.) Septic Tank: DIistance from nearest well_________________Distance from foundation------------------Materia!------------------------------------------------- No. of compartments4------------------------Size---------------------------- Liquid depth = CapacitY Disposal Field: Distance.fr nearest well__________________Distance from foundation____________------Distance to nearest lot ----------------- 4 1 Len th of each line-__- -- 1 Width of trench______9__ ______-___________ [�.. Number' f I' eS -- g �� t � `?`'_ ( Total length-----�d G---------------------- ' Type of filte material _ r__Depth of filter materia y, 2 I i * istance fr m foun t2n_ f l______-Di truce to nearest lot line _.___________ Seepage Pit: Distance to nearest we41___ __leil ,,� . . I.: • ' Depth----- l�F------------------ Number of its--�"'_ -- __-- Lining material__llr�� -Size. Dia�eter__________- ---------. Cesspool: Distance fr6Yfs"n2arest well_________________Distance from foundation___-___-___a_.____Lining material____--__________- ____.______.._____. 5i'ze: Diameer '._ :: -Depth --Liquid Capac ty.__ ------=-; y: Distance fr :nearest well--------------------- - ---:-----Distance from-nearest building----------------------------------------- 4 ------------------------------------------------------------------ D1istance to nearest lot line---------------- ------------ H ' --------------------------- - Remodeling and/or repairing ( ascribe'--------------- ---- ----- --- ------------ --- ----------•-------------------------------------------------•-- ------- ----------- ------- ---------•------------------------------•------------•----------------------- ------------- ------••----•--------------------------- = --------------------------------------------------------------------------------- --------------------------------------------------------------------- I hereby certify,fhat I havJ prepared this application and that the work will be done in accordance with San .Joaquin County ordinances, State laws, and rule's and regulations of the San Joaquin Local Health District. (Ow r-and&Contractor) ------(Title)--L ---�-------------------- ---------- ----------- ---- ------------------ ------ -II!-`moi- - -�- ------------------------- (Pilot - -------------(Plot plan, showing size of lot, lAafion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------- DATE---�� ---------------------------------------- r APPLICATION ACCT PTED BY --------- - ----------- ----- !DATE-------- - 1 REVIEWED BY =----------- ------- DATE_-------------- - BUILDING PERMIT ISSUED---------------- ---- --., ---------------------------- �Alterations and/or recommendations:-__ I .a...�.a..rt .T -------------------------------------------------------- ------------------------------------- -- ------------------------------`-----------------------•- « .. ------ F1 ^ -------------------------- NAL INSPECTION BY: Date [ . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California y } ti E5-9-2M B-51 Revised W-2100 `'"