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I APPLICATION FOR SANITATION PERMIT Permit No.- V7—b •__ (Complete in Duplicate) Date Issued 7 A lical-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 c hmpliance wiQ#h Coun y Ord'na e IN 549. JOB ADDRESS A D OCATIION-----/.--i _ •-------------------------------- Owner's Name----- ----�" �y ------ - - -- -- ----- --- --.... Phone--------------------- Address / -_-_--_(,i-__ Installation will serve: ! - Phone --------------------- Contractor's Name----- . ---- _ Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ otgl ❑ ther ❑ Number of living units:l`".1-- -_ C - umber of bedrooms -- Number of baths .� .-- Lot size -_- - --_-- iI ----------------------- Water Supply: Public-system:11 Com-munity�"System•❑ Private"[]"'Depth-fo Water-Table -- ft. Character of soil to a depth of 3 fee Sand ❑ Gravel ❑ Sand Loam Clay Loam Cli it Y ❑ Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ElNew Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanklor cesspool permitted if publif sewer is vailable within 200 feet.) ,. �j - Septic Tank: Distance f om nearesf welil/_ �sfi '" fromyf dar4y on_ , ' /.0.---- _ .Mate ��I �1� -------- ---- ----- .-. . No of compartments� Siz r Liquid depth---- ----f"_.----------Capacity..- r /� r Numb r om nearest Il_V _�' stance o foundation istance to nearest lo lin �Yi L�1 = Disposal Field: Distance 01!lines----_d_-- ---- _- Length of �ac line---------- � ---- lr ee- ' Width of french------ �} Type or filter materil�l th of fil r aterial_.: ....� A- - ---Tota length--------1-ZO-1----:------ ": R ..r, ,�.r,•. Seepage Pit: " Distance to"nearest well- --_}"- "^- e" ----__Disfance from fo dation--_.---- Distance to nearest lot line_----- ---- ❑ number of pits- -------------------Lining material------ r-- - ------ ize: Diameter-------- Depth .1, <. Cesspool: Distance "frprri�earest well-----------------Distancerom fo nda 'on'__ _---._,.Lining material---- __---- _-_______-- ❑ Size: Diameter-_-__.: 41"- - ---` ---- Depth-A.-_7 - �_ Privy: Distance r." '.'"=''•—. Liquid Capacity-- gals. ❑ Distance to m near vel----------------------------=-= Distance from•nearest building--_---------------------_- Priv ' i °n est`lott'lire-'� = <t �i y M, �/ Remodelin and/or re' a"'Vi describe#----------------------- ---------------- - ---------- - ••------------- -----------------------------•- = ----------------- •------- ------•- ---- t I�------------•--- -- - ----------•--- -------------- _.___.-___---.---__.-._--_..-----__.--- _--.____ w_ ------------ ------i--•-----------------------.---3---------------•-------------------.--------------------------------------•---------�-------a'---------------�•-------------------------------- I her, y certify than) have prepared This application and that the work will be done in accordance with San Joaquin County ordinanc s, Sta a laws, and rules and.re u! tions of the San Joaquin Local Health District. -.,_ y.. (Signed) ---- ------------------- (o By:--------------------------I--------�°---____ �' \ caner and/or Contractor) ---------------------------------------------------------------------------------•-(Title)-------------- (Plot plan, showing size of lot, location of system in relation to wells buildings, etc., can be laced on re e' side). i �I : P FOR.DEPARTMENT USE ONLY ; APPLICATION ACCEPTED 131 -- ..............i- ------ DATES ------------------------------------•------------- REVIEWED BY--------------------- --- -=-- ------ -�---------�--- - -------------- -�---�------ ---------------------------- •--- DATE--- 3 --- BUiLDING PERMIT ISSUED-_-._-.':---_--- -. _ ----------- - -------•--- DATE. Alterations and/or.recommendations:-_-.---- ` t 1 ---------------------------- ---- ----------------------------------•----------.--- -------------'---------------------------•---------•--1--------------- •-------- =--- ----------- 9� ---------------------------------------------- f �._- ------•-- -=-=------ - ---------------------- �-3 -- ---------------- - - ------- -} - •---•--- ---------- 7J . -. `' 7--•-------`'�'� --- - ---- -------- - ---- ----- FINAL- INSPECTION BY:.-----=- ----------------------------------------_---------- --- Date--------------" -------- SAN —SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . - Revised W-2100