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`�� APPLICATION FOR SANITATION PERMIT Permit No. # ill' (Complete in Duplicate) Date Issued ,5 Applicaa-ion 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. �/ 4 JOB ADDRESS AND CATION -7. �r ------------------------------------------ ---- ------------------------------------- Phone��_S _O S' z Owner's Name /' '1't' ., ----------- - --t Address------------1,2=3 --------- i, �� —-------------- ---•................................•---•--------------•---- ---•-••-•--•---.......... t �! Contractor's Name-----....... • ---L.�- — h" `" e Installation will serve: Residence ❑ Apartment House ❑ Commercial-❑ Trailer Court ❑ ` Motel ❑ Other °- ; Number of living units: -_ ____ Number of bedrooms -------- Number of baths .Z_ Lot size ___---- X__/_" -------------------------- Water a Water Supply: Public system [�ommunify system ❑ Private ❑ Depth to Water Table �_ ft. Character of soil to a depth of 3 feet: Sand ❑ � Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan ❑ Previous Application Made: Yes ❑ No D�New Construction: Yes ❑ No [____ ! ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i�ublic sewer is available within 200 feet.) f . ----`-- ------ { Septic=Tank: Distance from nearest well/ � Distancefrom foundation___ _4__- _.___.Material--(T__(T___. r___________ Jo. oftomartments_ _ cy______________SizeS_6�3�----------Liquid depth-----c �_ - Capacity----8e� -------• � Disposal Field: Distance from nearest well_�.__ __Distance from foundation._ �./.____.Distance to nearest lot line___�a__l___" Number of lines----- ---=------ Length of each line---- --------------------Width of trench----------------------------------- h ---�y-"------- -------- Type of filter material-s�-. �-Depth of filter material___. _9_�`_._____Total length_______ 4__-______________________ t Seepage Pit: Distance to nearest well - -_.___Distant l _ ne_ d__�_-_ Number of pits------!-----------Lining material_/7_--_)0._�_ Size: . , Diameter_�3_--__._-__.Depth-_f3__�_________________ Cesspool: Distance from nearest well-----------------Distance from foundation____-.____.--------.Lining ❑ material-_____________-__...__ Size: Diameter--------------- - -----------Depth---------------------- -- •- - - ----------------Li9uid Capacity---------------------------gals. Privy: Distance from nearest well---------"-"__--------------------------_....Distance frons nearest building_-__...____________._____--_____- j ❑ Distance to nearest lot line-------------------------------------- ------- --------------------------------------------- ---------------------------------------------- Remodeling ----- -Remodeling and/or repairing (describe):--------------------------------------------------------------------------- x t ------------------------------ ---- -------------------------------------------------------------•--•-------------•-------------•----------.. ..-----------------.. ..- -------------------------------- I ----- --------------- --I hereby certify thaf I have repared`this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa+e Paws, and rules and•regulati' ns of the San Joaquin Local Health District. Sined v`-� ``--------------------------- --( wner and/or Contractor) ( )-------- 9 rt J `�c By:---------- -------------------------`�E � .._. '�/ -- (bele)laced on reverse side (Plot plan, showing size of lot, location of system in relation tialts, buildings,g etc., canp ) FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-7..---------------- --------------------•------------------------------- DATE--------- - f . --•------------------ REVIEWED BY------ - DATE------- � --------- BUILDING PERMIT ISSUED---------------------------- - DATE = Alterations arid/ r recom ndations;_____________________ ____ --------------------------------------------------------- __ _ ---_.�___---__ 1 4`7V -- -------------------------------------------------•------ ------------------------------------------------ --------------------- - -- -----------------------------------------------1----•- -------------- --------------.----------------------------------------------------------- ------------------------------------- FINAL INSPECTION BY------- ------ -- �f"_Ii--------------------- Date----------'e`7 --------------------------•------ • r 11 SAN JOAQUIN LOCAL HEALTH DISTRICT �0 130'South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street `,�Stockton, California Lodi, California Manteca, California Tracy, California r, 12-s4 �`..-