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1� APPLICATION FOR SANITATION PERMIT Permit No -—f/ ,4 (Complete in Duplicate) Date Issued------ 7-�- .•------- Applica -ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This nnnlir_afion_is_made in compliance with County Ordinance No. 549. JOBADD S N=CAI-IUN 1 l --------- ------------------------------------------------------------------------------ Owners Name.__- -------------- - •-------------- -- - -- --- Phone ------------------------------------ - --------------------- - - ------------ Address__ - -- 4--------• -•- 9 % -- �7 Contractor's Name '—------------------------------------ Phone_!�_,S. i-4_ . `... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p --O Number of living units: ___ Number of bedrooms . - Number of baths _--J-- Lot size ____-�A__ -------------------- Water Supply: Public system ❑ Community system ❑ Private 2 ----Depth to Water Table 3a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [jj� New Construction: Yes ❑ No [t�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic nk: Distance from nearest well ______.________-Distance from foundation -------------------- Material ------------------------------------------------- N _____.______-__-----------_____________________- No. of compartments -------------------------- Size ----------------------------_--- Liquid depth -------------------------- Capacity ----------------------- / / Disposal F Id: Distance from nearest well --- _�o__+�.______Distance from foundation ___�'�_--___.Distance to nearest lot line -%S______ rn Number of lines -------- /----------------------- Length of each line --- --*4--------------.Width of french____ fesR'_----------------- it Type of filter material_S�_..T�.O_T�_ .,___Depth of filter material _---_/,?.- ....... Total length --_-.__.3d_'___________-___..____ Seepage •it: Distance to nearest well ---- /_4 --- __------- Distance from fpu clation_..x2j�?_...___.Distance to nearest lot p 7 5 �� --- Depth---------------� Number of pits-____ -__ ------------- Lining material __s�_ � Size: Diameter ____._ ___ � � r Cesspool: Distance from nearest well_________________ Distance from foundation ---------------- -,lining materiaL_____-__._______._________ d ❑ Size: Diameter------ --- ------------------- --------- Depth ------------------------------------------------- .--Liquid Capacity- ------ -------------------gals. 3 O Privy: Distance from nearest well ------------------ _---------------- .------------- Distance from nearest building ------------------------- .--- _----------- . ❑ Distance to nearest lot line ----------------- ------- ----------------------•---------------------------------------------------•------------------------- ------------- Remodelingand/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 it ordinances t e 1 ws, r4-rmles and regulations of the San Joaquin Local Health District. ----------�- `------------- -- Contractor (Signed)-------- ••------) By:------ f�---�f1 -- -- --- ----------•---------------------------------------(rtle------- ----a - (Plot plan, showing size of lot, location of sy min relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ -----------------------------------------------------. DATE-------/--`-----r-�--;------------------------- REVIEWEDBY----------------------------------------- - --------------------------------------------------------------------------------- DATE ------------------------------------------------------------ BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ DATE ------------------------------------------------------------- Alterationsand/or recommendations: ------------------ ------------------------------------ --------------------__-------------------------...---------------------------------------------------- FINAL INSPECTION BY--------------- - -------------------------------------- Date------- 7`SY..7 130 South American Street Stockton, California £S -9-2M ; . Revised W-2100 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street Lodi, California 132 Sycamore Street Manteca, California 814 North "C" Street 3 Tracy, California