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J - A,t APPLICATION FOR SANITATION PERMIT Permit� No. . -,'7 --_- ` W' II . I (Complete in Duplicate) Date Issued Applice�ion is h reby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi s,application is made in compliance with County Ordinance No. 549. It ff JOB ADDRESS AND OCATION___ :2 ------------ - = - 0- ----------� ---- Owner's Name _7 Rv_ev 00 ------------------------- Phone__.- ------- - - Contractor's Name_______ _�Q- / _ �-------------- - -----•------------ ---------------------•-------------------•--- Phone_,�'_ 4q"-'-. ' �-•-- Installation-will serve: Residence (] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _:_.___ Number of bedrooms -------- Number of baths -_y Lot size ater`Supply: Public system -R Community system ❑ Private ❑ Depth to Water Table Y�. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No Dg�_ New Construction: Yes ❑ No 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is Tan istance from nearest well_________________Distance from-foundation---------------.-_Material---- - No. of comparfimenfs---- -----------Size--------------------- _------ _ Liquid deph-------------- ---------=CapacitY----- ----------------------- - W isposal Fi Id: Distance from nearest well-----------------Distance from foundation ___________Distance to nearest lot line--------..____._. i Number of lines---•-----•------------------ Length of each line----------------_--- ------------------------Width of french----------------------------------- ---------of filter material_________________________Depth of filter mater ial_____________.______-_Total length------------------------------------------- Seepage Pit: Distance to neares# well istancef,rom foundation_ 45------_--Distance to nearest lot line__ - Number of its. p 'LR..�.. Lining material__-- -i_ Size: Diamefier_ -. Depfh_S3 ------------- Nu: -------- Cesspool: Distance from nearest well_________________Distance from foundation-------------------- Lining material--------------------.------ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-- ---gals. Privy: Distance from nearest well____________________ ____-_______Distance from nearest building ❑ Distance to nearest lot line-----------------___________--_- Remodeling and/or"repairing (describe): _-_ __------_ r ---•------•--------•----- ------------ -I1 `�'1r .c9 - p ------------- ........------------ ------- U�----------- -------------�--- ------•--•- I.hereby c?rt! hat-f-ha a prepared thi application and that the work will be done in accordance with San Joaquin County ordinances, Sate laws, and rul s and rei gul ,ions of the San Joaquin Local Health District. {5i ned 9 ) . ----- . -- - -.--- O ner and/or faontractor) BY: = -------- -------- -- ----- - 1•--.�- {rtlef (Plot plan, showing size of lot, location of system in relation t© wells, buildings, etc., can be placed reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- - ------------------------------------------------- ------ DATE-_---- REVIEWED BY_.. /7__ - - �---"� --------------- PERMIT ISSUED --- ................. ------------------------ ----------- DATE. Alterations and/or recommendations-----------------------------•------ -------------------------------------------------------------- ------- ----- k FINAL INSPECTION BY------- ------- V •--•---•----------- ------------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reet 132 Sycamore Street 814 North "C' Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9—.2M ; Revised W-2100