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APPLICATION FOR SANITATION PERMIT Permit No. - -` - `� (Complete in Duplicate) Date Issued .�1 __ ApPction 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. B ADDRESS AND LOCATION ` +r ."'------------------------------------ JO 711-1) j/-- f Owner's Name------------------------------------- �.�2. - ----sJ~ 1---)-----�----'�---------------------- Phone `'"'`° Address--------------------------------------------------- - - - -------------- -- - - ------------ ---------------------- -- Contractors Name--------------------------------&' -i , - � .°r Phone jI Installation will serve: Residence 2( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1____ Number of bedrooms 117"' Number of baths __ __ Lot size _--__�G --`-- -- -�'` r Water Supply: Public system it Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 17V Hardpan ❑ Previous Application Made: Yes ❑ No%—New Construction: Yes)No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if plic sewer is available within 200 feet.) « �- �, 1-----------Material----- ---------- - -- Septic Tank: Distance from nearest well h/1--Distanncce from f and n -- i+ No. of compartments----------------X___---Sizeel-F�--- - �iquid depth_ --------------Capacity---g�?Q_. $ L.-Distance from foundation___ ----- Distance to nearest lot line_____--_I©-`� Disposal Field: Distance from nearest well- ' �� Number of lines------I------- - ----- Length of each line-----�--�_----------Width of french------�'�------------------- 41 ---- ----- Type of filter material____ q------ ' l�--Depth of filter material______^ _---- Seepage --- Total length------ -_!'_____________________ Seepa e Pit: Distance to nearest ell-._► °�___--Distance ro fo ndation--�_(�------Distance to nearest lot line---A0— 7- Number Diameter of pits------�-----------Lim ng material---____-- -- � _ -- c3_,3_`r__.Depth--CR_-0_'---------------- ___Distance from foundation--------------------Lining material_____-------____- Ces❑pool: SizeD�st:Diameter rce from nearest well------------- ---Depth--------------------------------------=-------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__------------------------------------------------Distance from nearest building----------------------------------------- n Distance to nearest lot lire----------- ---------- ----------------------------------------------------------r---------------- Remodeling and/or repairing (describe):------- --------- ---------------------------------------------------------------------- ---------•------------------- -------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ------------------------------------------ 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, rules and regulation of the San Joaquin Local Health District. } Contractor) # f` ----------------------------------------------- -- ------- (Signed} � � By � ----------------------------------------------------------------------------------(Titl �!C i� ---------------------------------- , s Ian, show? g size of lot, locatioA system in relation to wells, buildings, e (Plot plan, can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ; V -1/-- ----Z-- DATE------ -_-- --� '" - ----- --- ---- ----- -------------- REVIEWED BY -- ------- ---- DATE-- --- -------- --------------------------------------- ------ ----------- ------ ------------------- BUILDING PERMIT ISSUED-------•------------------- - --------------------------------- DATE Alterations and/or recommendations:------------------ -------- -------------------------------•------•----------------•-----------------•-------------------- ----------- -------------------------------- ------ ------ FINAL INSPECTION BY:-------- _.---- ---------- Date----- - ---1--/-- - -j- JOAQUIN LOCAL HEALTH DISTRICT 130'South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M B-51 Revised W-2100