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(� APPLICATION FOR SANITATION PERMIT Permit No. _4/ "7 (Complete in Duplicate) Date Issued ��q /S3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described This application is made in compliance with County Ordinance No. 549. �r �" f7��0SS' �,�'eHr JOB ADDRESS AND LOCATION.___-" c ke -" 1 Owner's Names ' . . _ r S . --_ --------- ---- ----------------- ------------- ------ Phone-�o "f r�� r Address e I ---- +------------ �------------------•-------- ------------------------ Contractor s Name---------------------------- ---l41h�,1G�" 3----- -- --1"}--�------------------ _ ___ ---------- ---------------- ---------------- Phone----- Installation will serve: Residence Apartment House ❑ Commercial [I Trailer Court [] Motel ❑ Other ❑ Number o€ living units: _/--- Number of bedrooms Number of baths __/-__ Lot size -----...�P Water Supply: Public system & Community system ❑ Private ❑ Depth to Water Table _ z ft. ?/&. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No §C New Construction: Yes ❑ No ❑ ij n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfiic'Ta k: Distance from nearest well----------------- from foundation________________ �Z I Material No. of compartments---- �--------- --------Size---•------------- - ---- ------------------- - �f— Seepage --------------Liquid depth--------------------------Capacity------------------ Disposal Feld- Distance from nearest well____------------Distance from foundation____"______________ Distance to nearest lot line_.__"----._._ I� f' In Number ai lines_---__._ ---------------------Length of each line------------------------------Width of french Type of filter material_- ------------------Depth of filter material---------------------------Total length--------- ----------•-------------------- Pit: Distance to nearest weILJ -0-4,C---Distance ,f�r, m f undation_/ `__"____.Distance to nearest loft line__._o� Number of its--_!! .� -- p 1------------------Lining mate _ .Size: Diameter De th_ ----- ---- - -- -- Cesspool: Distance from nearest well------------------Distance from foundation---------------.__-:Lining mweridL"_ -_.________- --------------" --. ❑ Size: Diameter Depth ---------------Liquid Capacity- -------gals. , Privy: Distance from nearest.well--------------------------------------------------.___"."_._____""_.__._Distance from nearest building--------._._______"_--"""__-""_- El Distance to nearest lot.line________________.._____.: -_ ------------------ Remodeling and/or repairing (describe):__ --•---•--------------•------------------•---•------------- - ---------------------------- ------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------.------- I herebyc r y that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stalte I ws, and rules and regulations of the San Joaquin Local Health District. ( �Si ned �i :�_ ----------- -- - )---------- -- `------- ---M er /.w Contractor) By: -------(Title)....cs r . �'CQ --- (Plot plan, showing size of lot, location of syste relation to wells, b ildings, etc., can be placed on reverse side). 1 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_"-___"_--"-- ___-___ DATE-..-------- , REVIEWED BY --------------------------------- ---------------------------- -- d �---------------- BUILDING PERMIT ISSUED----------------------------•- -- - ----- -------------- ------------- ---------- DATE---- - -------- --- ----------•- - - -------- -------------------------------------------------------- . DATE----.------------------------ - - ---- Alterations and/or recommendations ------------ -------------------- ------------• ---------- ------ Dat------------ -------� ---------------------------------------------------- FINAL INSPECTION BY: - Ago - . .. ..._ SAN 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 10-52 Revised W-2100 f