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t APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ` Date Issued _2- 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____________ _ --- Z .Q( •------------/�/------- Owner's ------------------------------------------------Name_ _ -------- -,G� °O. Address ---------------------------------------------------------------- -- Phone----------------------------------- Contractor's Name_ -------------------- _ " ---••----------------------------------- Phone-----•--------------------------•- Installation will serve: Residence ® `:Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _- Number of bedrooms 3 ` / �.;._ Number of baths - __- Lot size _____�D-a--------------------------------------------- Wafer Supply: Public system ® Communitysystem � 3 Y ❑ Private-'❑ Depth to Water Table ________ ft. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ Y ❑ y ❑ Adobe En Hardpan� I Previous Application Made: Yes [] No m New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest wellDistance from foundation_ _ _" /�p / y -� ______.Material1-f __- No. -of com artmenks----_---__ Size-__ it' p �� -��_�j___:___Liquid depth___"__LCL_ . -- Ca acit pp P Y Gj�` Disposal Field: Distance from nearest well`-_.�;--Distance from foundation_ __ ------- ---- tante to nearest Number of lines_____--_____-- _--------- .Length of each line________. __¢. Width of french---------- ----- --- -----%_ Type of filter ma#erial__S._T- l � r r Yp -- -- J .Depth of filter material---- --- - -----------Total length---------�---�t�_---- .------- r •----- '1 Seepa • : Distance to nearest well �' �s#.aRce rom foundation __�_-__m__wq-stance fornear� t line-----____________ ----------- Number of.pits- Lining material-------------- "Size: Diameter_--------------------- Depth----- __ ------------------- ? _______ Cess o Distance from near st ___ /" / , Pyr_. Distance from ing material__ '�tl Size: =Depth -_ - -------------------- _ - ---- -- ---- Priv t �� ----,r -�.- _- - _� .-� - - - .- _.�v. .t apacitY ------gals. Y Distance from nearest ural).______--------+_ - - - - ' � ____________________________Distance from nearest building` lineg Dis#ante to nearest lot � .. _,,.,,r ---------------- ---------------- - - - Remodeling and/or repairing fdesrriL_ )___________ `- _.-- ---:- r --- -- --•-----------------------------------•-------- ' = F r ave p p cthis a pication and that the -------------------------•---------------------------- ------------------------------------------------------- ------ ordinancreb5tafetiawsh andat I rules ales a d re ulatro ------------------------------------------ --- - will �� °-- in ac accordance i - Sa --------------------- I work will 6e done in accordance with San Joaquin County g ns sof.the San Joaqurn Local'Health District. (Si ned g } �, ------- -------------------------- -----(Owner and/or Contractor) By------------------------------------------------------------------------ t Trtle ------------------------------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ----------------------- — ' DATE-- REVIEWED ---- --------- ---------------------- BY ---- - f—E-: DATE ------ --------------------------------- BUILDING PERMIT ISSUED_. t -------- ------ --------- --• --•-------- DATE Alterations and/or recommendations:________________----- - ..... / ---- . , V_-- ----- _.___.__".___________ ------------------------ ------------------ -----••----- AN r --------------------------------------- ------------- ------------------- ---------------------------------------- y FINAL INSPECTION BY__ _______ __ _ ~ Dafe .r ] ♦ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streot 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