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�$1 APPLICATION FOR SANITATION PERMIT - Permit No.311__...... (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. JOB ADDRESS AND LOCATION--:A��TI``ON:___�------ f {` /' � = y ,. ------------------------------------------ Owner's Name = --------�4•�_! r� ---_ �4 �7 - Phon - f Address ----- rL' � / 4 / Contractor's Name-----;---� -;-'- �' = /2/.,{cZr[ .__ Phone car-- W Installation will serve: i Residence $e--Apartment House ❑l/ Commercial ❑ Trailer Court ❑ /Mofel ❑ yO+her ❑ Number of living units: _�-----Number of`bedrooms 1___-. Number of baths ./__- Lot-size _-�__��/. Q_ -. -; ------- ----- Water Supply: Public.system El Community system El Private Depth to Water Tab]4ZJ7ft. Character of soil to a depth of 3 feet: Sand ❑_ Gravel ❑ Sandy Lo;�PNO Clay Loam E] Clay E] Adobe ardpan El 1 Previous Application Made: Yes El No e' New Construction: Yes ❑ '" r i TYPE`OF INSTALLATION AND SPECIFICATIONS: l 1 (No septic +ank'or cesspool permitted if public sewer is available within 200 feet.) i S Ta Distance from nearest weIIC�7_.d______Distance from foundation__.�Q___.__-.Material ____. --1r---------------_----------- Septic LJ� c !/�/ No. of eompartments__ ______.____'__Size l'� rl --:---Liquid depth____ -----_-Capacity_____P,J&.__. Disposal Feld- Distance from neare t well-.6-d-------Distance from fcund �ation__� ------------Distance to nearest lot Iline---�..... [�' Number of lines---- Length th of each line____ _ ________________Width of french------ __._ Type of filter material:: �-K-__-Depth of filter material------`_F--------Total length________-�U_______________________ Seepage Pit: Distance to nearest well----------------------Distance from founda+ion--------------------Distance to nearest lot line__.__.____._____- ❑ Number of pits-_-------------------Lining,material-----------------------Size: Diameter------------------------Depth------------------------ Cesspool: Distance from nearest well______________`Distance from foundation--------------.___..Lining material------------._..______________.___ Siza: Diameter = = -------------------= -Depth-------------------------------------- :Liquid Capacity----------------------------gals.- Y [ Priv Disthrice from nearest well_____________ _ _ .-- __ ______--._.- ____._.---------.-Distance from nearest building----------------- El Distance to nearest lot line.w----------------------�- -- - - --------------------------------------------------- ---- Y ']� _�_•- f"""--_ Remodeling and/or repairing (describe):-_.`---------- -- --= -- � --- -------- - •= -- -� - -- �:---•C""""�`-- - ----- - ---------••-------- 1 F ------------------------------------------------ --------------- - - -------•------ - ----------------- ------------------------------------•---------------•----------------------------•----------------------------------•----------------------------- ------------•------------ I 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 regulationsyof the San Joaquin Local H alth District. I Y (Signed) Owner and/oContractor r-------Title (Plot plan, showing size"of lot, location of system in relation to wells, buildings, a+c:;�an be placed on reverse side). FOR DEPARTMENT USE ONLY l: tAPPLICATION ACCEPTED BY--------------- -- - - ------ ----------------------------------------------------------- DATE------ :- L., i REVIEWED BY----------------------------------------- -- - --- -------------------------------------------------- ----------- DATE------- 4 BUILDING PERMIT ISSUED---------------------------------- ----------- DATE------------------ Alterationsand/or recommendations-------------------------- ------------ ----------_--------_-----------------------•---------------------------------.......------------------------------- -----------------•--------•--•-•------ ----------•-----•---•------------•-----------•-------------------------•------------------------•---------------------------•- -------------•------------•--------------•----------- -----------------------------------•-----------------I---------------------------------• ...........I--------------------•-•----------------------•------•------------------------•----- --------- -- -------- - - ---------------------- ------------------------------------- ------------------------------•--- ------------------• FINAL INSPECTION BY------------- d i ------------------ Date------------q---) - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0 e Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 10-52 Revised W-2100 ��