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y APPLICATION FOR SANITATION PERMIT Permit No. _.711_------------- 1 7� {Complete in Duplicate) g� Date Issued ------- Applica;ion is hereby made to the San Joaq Local Health District for a permit to construct and install the work herein described. This application is made in compliance wit ounty Ordinanc%No. 549. JOB ADDRESS AND 1_0C,4710 ----------------------------------•--------- ------�----//_ Owner's Name--- -----•--- --------- '----------------------------- ------- --- Phone.-T-_-- ` 6� " ----- ------------------------------------ „ _... _.. Address--------------------- - ---------- --.....---- --------------------------- --------------------- .._....._.... .------ ----------------------•------------------------•- L: Y Contractor's Name--- j--�--- -- ---- -- ------- - --------- Phone---------------------------- Installation will serve: Residence OZ" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths _ ____'Lot size --`ap-!ic----: ----------------__--_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table-_:_':--- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ CI Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ Na TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } -%20( 1Jd = .Mat rel -------------- Septic Tank: Distance from nearest well-,fDv_______Distance from foundation___ .rt�_. . �G /��IC/(, _-Li uid de th t/_-...__.-__:_Capacity..,?s p - �If ' [ No. of compartments------- --------------Size.�l "fd G p. - f � Disposal Field: Distance from nearest well.................Distance from foundation--..-----_---.--.--.Distance to nearest lot line---.___..-------. i ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- XrS 7 Type of filter material-------------------------Depth of filter material-----------------------Total length---------------------------------------- � .' Seepage Pit: Distance to nearest well ...._.--------------Distancefrom.foundation-____x_______---_.Distance to nearest lot line_-----__---_--_- " ❑ Number of pits------------------•_--Lining material-----------------------Size: Diameter------------------------De th 'V Cesspool: Distance from nearest well-----------------Distance from foundation_..-----------------.Lining material--------------_--____.-______---___-. ❑ Size: Diameter----------- --------------------------Depth-------------------------------- ---------------------.Liquid Capacity--------- --- -gals. Privy: Distance from nearest well.------------------------------------------------Distance from Barest building-----________.._._._-__-_-__.__.._---._. ❑ Distance to nearest lot line----------------------------- --------------------------------- ----------------------- ------------------------------------------- Remodeling' and/or repairing (describe):-------- ------------------------------------------•------------------ = { ---------------- ---------------------------••-•--------------------••-- -----• ----------------------- ---- 1 _ � x ----- ----- I hereby certify at ve prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, State laws, nd ales and regulations of the San Joaquin Local Health District. (Signed) y Owner and or Contractor BY= ----- ---- (Title) (Piot plan, showing 'ze'of to+, location of syste m relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-----------_-------------- ---------- --- ----------------------------------------------•---- DATE-------- --- -----------------::-------- REVIEWEDBY------------------------------------ ------- ----- ------- - -------- ------------------------------------------------------ DATE----- -------- BUILDING PERMIT ISSUED----------------------------------- ----- ------------------------- =----------- ----------• DATE--------------- y� Alterations and/or recommendations------------------- -------- --------------- ......... _ =-F----------------------------------------- ---------•-------------------------- ----------- -- -----------------------------------------------------------------------------------------------------..--------------------------------------------.----------------------------------------•---------------••-- ------------------------------------------------------------ ---------------- ---- ------------- - ----------------------------------------------------- ------------- ------/__ ------------------- Date ------------------ FINAL INSPECTION BY:. °1 - Date----- ��- ---------- ad ;r SAN JOA Q 'IN 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 .i ES-9-2M 14s44s aTw000 12-54 r'`