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APPLICATION N FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued . Av4 l' Applicatio is her�hy made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549, described. JOB ADDRESS AND LOCATION......._ ---------�----- -I• D f, I --- ---------------- Owner's Name------ G� - �------------------U/ -,Se71Y_------ __ Phone ~ ------------------------------------------------- Address- - ------------------- - --- - --------------- Contractors Name --------- - - - -- _-- ,�_ . (tee---------------- Phone.-`^ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court I] Motel 0 Other ❑ k Number of living units:/0-__ Number of bedrooms/47__ Number of baths A&— Lot size Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam ❑ Clay ❑ Adobe W .Hardpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r1 Se t'c Tanks Distance from nearest well_________________Distance from foundation___________________Material____________.___________. O ------------ No. of compartmems------------------------- Size--------------------------------Liquid depth--------------------- �- ----Capacity-- -------------- -- r Qisp al, d: Distance from nearest well-----------------..Distance from foundation--------------------Distance to nearest lot lime_________________ Number of lines------------ -------- ------______Length of each line_______________ - -----------..Width of trench-------------- ------------------- Type of filter material-------------------- ---Depth of filter material-----------------------Total length----_-------------.I Seepage Pit: Distance to nearest weff__ IAW----__Distance from foundation____&-_______ 1 ___.Disfiance to nearest lot Irne___:�____.____ ' Number of pits_4N4_________Lining material_-RA -Ott------Size: Diameter_ Jd Depth--21'-If------------ Cesspool: Distance from nearest well_____________" Distance from foundation---._----------------Lining material_______________JI,____ --------------- ❑ Size: Diameter ---------Depth ------------------------------- Liquid Capacity.. ryl gals. Privy: "Distance from nearest well_ _____________________m_____ "_ Distance from nearest building "" , El Distance to nearest lot line_ - �« .. Remodeling a d/or re airing (describe::_____ _ R e ------------------------�------_��------------------- --------------------------f�----------------------.--:-------•-----•- -----------• --------------------------------------------------------------------------------------------•- --------------------•-------------------------------------------------------------------------------I1------------------- I hereby certify that l.have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r les and regulations of +he San Joaquin Local Health District. (Si ned 9 ) --------(Ow7er d/or Contractor) r By:-------------- /j � -•---�.� Title ' - ----------- ------------------- ( } ;E - �1 " (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p] sed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _ -- ---_------ DATE___'_ 11 ,y� IEWED BY------------------------------- ----------------------------------------------- ------- -- - DATE - ------------ BUILDNG PERMIT ISSUED ------------ - -------- � �--------------•--- DATE �C ------------ Alterations and/or recommendations----------------------------------- --------------------•-------------------------I----------------- ------------------------------------------------------------------------ ------------------•----------------------------------------------- --------------•- ------------------------------------------ -------------------------------------------------------- v . FINAL INSPECTION BY:" 7f 2a ..�—,� ------------- --------------------- FINAL ------- ----------- Date = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 5 camore Street F y 814 North "C" StlrIlIeef Stockton, California Lodi, California Manteca, California Tracy, Californid ES-9-2M B-51 Revised W-2100.