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APPLICATION FOR SANITATION PERMIT Permit No. ............ (Complete in Duplicate) Date Issued 7-- _7/ 3 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___(In�1_�._4-V..-_� 1 -- ------ Owner's Name------------•--- ----=----•-•----- - - ----- - ---------- ----- Phone -------- Address. �� 1,� - � a. `F; .�i� '_-. .--. .- - Contractor's Name----------------- �` ` ------------ ------------------------------------•------- Phone.----.r1'-- �v� Installation will serve: Residence Y Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f__ Number of bedrooms _Y__ Number of baths --e--- Lot size Water Supply: Public system ❑ Community system ❑ Private JK Depth to Water Table 'A__ ft..Pe- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No )f New Construction: Yes Y No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept Tank: Distance from nearest weIL6jo_`_--__Distance from foundation_4�or___-_Material-- ___ No. of com artrnents-- •q p � "' ------------------------- ---------- p - Size_ Liquid de th_J�i ------- Capacity9�G----------- f:c3"' Disposal Field: Distance from nearest well-----------------Distance from foundation_------_--_-----_-Distance to nearest loft line--__. _.---____-- ------Length of each fine--------- ------ ------------Width of french ------------- f ❑ Number of lines_____________.-.---._ ._ i Type of filter material------------------ Depth of filter material-----------------------Total length--------------------------------------__ Seepage Pit: Distance to nearest well_'d__- --------Distance from founclation-Ap--------.Distance to nearest lot line---_-_-_ it f Number of pits- ---_---_-_____Lining material��___._.__-Size: Diameter_- _-- Depth JO-10-------- _` _-_�S Cesspool: Distance aterom nearest well _Distance from foundation----____----- ------.Lining material-------------_------_---___ .n ❑ Size: Diameter ---Depth---------------------------------------------------------- ------Liquid CapacitY------------------------- Privy: Distance from nearest.Well---------------------------------------------- Distance from nearest building ❑ Distance to nearest lot-line--------------------------------------------------- Remodeling and/or repairing (describe): -its �•cc.��.r.r- �"------------------•-•- ---- -------0- -- -------- ----- ------- - ----------------------- f _. ------------------------------ ------------------------------------------ ---------------------------------------------------------------------------------------------------------•--------------------------------- - I hereby certify that I have prepared th application and that the work will be done in accordance with San Joaquin County ordinan , laws, and ruls and regula ions of the San Joaquin Local Health District. {Signed}-_-_ ------------------------ ---- - Contractor) --- ------ - By:------------------------------------------------- •---------•------- -------------- {Ti+leP- lri�1 �r r _- (Plot plan, showing size of lot, location of system in rely+i. to wells buildin s, etc., can be aced.on reverse side). FOR DEPARTMENT USE ONLY APPLICATREVIEWEDON BY ACCEPTED BY- ----------- ------------------•------------------------------------••----------- DATE ------ ---- ------------------------- -----------------------------------•-------------- -- DATE-- -.X- - -------•-----------•--------------------------- UILDING PERMIT ISSUED---••---------------------------- ------------------------------------------------------------------ DATE------ - Alterations and/,or rec mrimendati nr•---__ - ------- - - - --- _�� h--- --1-- Q °� --- ---------- -- -------- ----- ----- -- --- - .�_ �' e � -------- -t ------ -l5-_ - Wit"' - ----------------------------- �--•-- - ------------------------------------------------------------------------ FINAL INSPECTION B Date----------- ------- 1-_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street 5toek+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100