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APPLICATION FOR SANITATION PERMIT Permit Noc74--P-7--- - (Complete in Duplicate) Date Issued J-/A,_- /-S -all 1 3 Application is hereby malleo t e San Joaquin Local Health District for a permit to con ruct and inst I t w herein described. This application is made in compliance with County Ordinance No. 549. O>w�Q r � � ,------- .. JOB ADDRESS AND LOCATION-.,44.- --- --- -----� .Phone_ ------ - Owners Name------------------- -•-- - - -------� --------�------------------------------------------------Phone [[[ -------------------------- - - - - -- Contractor's Name _-------------------------- Phone_ ' --p Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_- Numberof bedrooms Z-- Number of baths ll_ Lot size ___f A.ik---------------------------------- Water Supply: Public system ❑ Community system 0 Private 2C Depth to Water Tablejo ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)( Hardpan ❑� Previous Application Made: Yes ❑ No)!L New Construction: Yes jr No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / V� �_ Distance from fo dation___ _______--.Material____________ _ _ 4:— Septic -__-- -t Tank: Distance from nearest w IL__ ________ _ No. of compartments__I�[______ ---------Size, 46 jd-"-- Liquid depth---c'.�e_ ___________Capacity��p__�sI Disposal Field: Distance from nearest Weil_ 0-_____.Distance frem foundation__-' ------.Distance to nearest lot line__�_Q Number of lines______,(-______ _ Length of 'each line____.,.�p_�__ ------Width of trench__�j__ �� --------------Type of filter ma+enai___�_ ]! �l Depth of filter material___�_��j-----_Total length_-_ a0-- ----------------- ' e 2' _ Seepage Pit: Distance to nearest well_-pA_-____ Distanc from f undation___45.Ef_.____..Dista c to nearest lot line--- - -Distance _ i Number of pits----- ---------------Lining materia ___ :Size Diameter-' " __-----"'.Depth::.. - --_---------------- ' � . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------_ ❑ Size: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity.----------------------------gals. I Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building---------------------------------------a ❑ Distance'to nearest lot line________________________________________________--------------------------------------------------------------------------------------------- 1 , Remodeling and/or repairing (describe)------ -------------------------------------------------------------------------------------------------------------------------------------------- -- --------------------------------------------------•----------------------------------------------------------------------••----------- -----------------------------------------------------------------------------------------•-------- ...------------------------------------------------------------------------------------------------------------------------------------- -------------------------------•------------ I hereby certify that I ha a prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StateZ, B nd 1 and req ations of e n Joa uin Local Health District. (Signed) Contractor or - L) ---------------------------------------------------------------(Titley �'1 - �.. +- . (Plot plan, sho ng size of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). II FOR DEPARTMENTUSEONLY JJ// IAPPLICATION ACCEPTED BY--- ----- --------------------------------------------------------------- DATE 7�- ----------------------------------------------- ----- DATE----------/ z REVIEWED BY-------------------------------------- -------------------- BUILDING PERMIT ISSUED------------------- ----- - -------- DATE F > Alterations and/or recommendations----=--------- ------ ----------------------------------------------------------- -------------------- ------------------------------------------ - -------------------- --- ---------------------------------------------------- 1 FINAL INSPECTION BY:__---____-- ........... --------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT M 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Trecy, California ES-9-2M 8-51 Revised W-2100