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-2/) T^ Permit No. APPLICATION FOR SANITATION PER IT • (Complete in Duplicate) Date laued _2-------------.`-� made to the San Joaquin Local Health District for a permit to construct and install the work herein described- , Application 1s h2reby q This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. ----------.i_.� Owner's Name_------------------------------------------------------------- k apoe.�-------- ----------------------------- ----------- -------------- Phone. �� Address------------ ------- 't"' . --------------------------------- Aa ti��2e1 ,! - - - -� ----- Phone = I� 7-------- Contractor's Name------------------••--------•---- ' _ Installation will serve: Residence ❑ Apartment House Cg Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,�- ,. ° Number of living units: _-______ Number of bedrooms ____ __ Number of baths _______ Lot size _ �4----------------------------------------------- Water Supply: Public system ❑ Community system 0 Private A Depth to Water Table _qD ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe`[4- Hardpan ❑ Previous Application Made: Yes ❑ No',R5-,, New Construction: Yes ❑ No ❑ f c � �.-:► 'Le-- 'yam TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic_ Tank: Distance from nearest well________________Distance from foundation--------------------Material_____-_.________________-__________________---_. No. of compartments------------`--�-----------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from neares wellL_�1`Q-0___._.Distance from foundation__-_f�--.-___Distance to nearest lot line___ Number of lines---------_.-----I__ ai-- __---._Length of each line_,_--------5----------_Width of trench-_.------ _�_••_________--- �. �- Type of filter material__. - ___2�,---Depth of filter material____-/-S-_�______-__Total length-__��___________________________-_ _ D' t nce to nearest lot line__.______ d Seepage Pit: Distance to nearest well..___-Q_�____Distance from fqundation__ ___________U �r b� Number of pits---------1----------Lining material_,%_"____$_---Size: Diameter_____________________Depth----- Cesspool: -___�.c _____________. Cessp ol: Distance from nearest well-------------------Distance from foundation--------------------Lining material---------:-_______________--....__ __. (A I ❑ Size: Diameter--------------------------------------Dept h---------------------------------------------------Liquid Capacity ---gals. - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------.._.------------ ❑ Distance to nearest lot line---=--------------------------------------- ------------------------------------------------------------------ Remodeling and/or repairing (describe)------------------------------- ------------------•-------------------------------- ---------------- ` 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, nd�rules and regulat iam�of the San Jog` in Local Health District. ! ., h - ----- { Contractor (Signed) '4G ---------------- ----- ) 4--- -- By•------- (Plot plan, sho i g zsi a of lot, location system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY---------------------- DATE------------ -� -45 - REVIEWEDBY-------------------------- -- DATE----------------- -----------:---------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------- ------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------- ----=-------- ------------------ --------------------------------------------------- I - --------------------------------- FINAL INSPECTION BY:-------V V ---------a------ ------------ 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 ' ES-9-2M 8-51 Revised W-2100