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APPLICATION FOR SANITATION PERMIT Permit No.C:j.,—_{;:?---OP4 t 7 (Complete in Duplicate) id Date Issued _F?'/.Sc_3 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 ------�f�/_ rl f=---- l Fd. - ------ Owner's Name 4 •__l�fC? ----------------------------------------------------------- e _ Phone----M-E-�✓-,��/_�-�.�d Address-------------------- , _- �.M..1r_✓.�.1 Contractor's,Name------ 1414'1. �---f1/61------------------------- ----------- Phone---19--15 Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .--_____ Number of bedrooms - -. Number of baths ..l___ Lot size __� -` " - ------/tea--- --------------- ---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table A) ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑' No New Construction: Yes ❑ No 2 TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material_-______-_._- f n7—/ ` No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacit ----------------------- Disposal Field:. Distance from nearest well-_-9Q_� Distance from foundation__a-Z----------Distance to nearest lot Number or lines_______:___1------------_-------Length of each line_---____-.0---------------Width of french..... �' Type of filter material_ �,f -----Depth of filter materiel_-__- ---Total length____. {,�' ',_�',� yG� See pa Pit: Distance to nearest well_-/--QO-'-------Distance from foundation__- 6__i------Distance to nearest lot line---- Number of pits------�------------Lining material_4FIr«/----..Size. Diameter----3_J--------.Depth-------e4a-./ ------ - 4 rom Cesspool: Distance et6r-. Barest wel!_________________Distance from foundation_-----________._---Lining material--------------------------- ^ *%El5ize: Diame#er --------------------- ----------Depth----------------------------- --------------:-----Liquid Capacity----------------------------gals. Privy: Distance from nearest weft_____---__.____________ _________ g______________Distance from neares# building M ❑ Distance to nearest`lot'line"`.___^""'-•_---- --_ R A Remodeling and/or repairing (describe):------&'_a f - .� _ f_._-•---------•----------•---- •- - -- --------------------------•-----------------------------------•-----------"------•-------------------••------•--------------------•---------- -----------------------------•-------------•------------------ -------------------------- -------•-•---- -----------------•------------•-----------•--------•------------------- -------•------------------------------------------------------•--------- ------------------ ----- 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, and rules and regulations of the San Joaquin Local Health District. (Signed) _.� D "I----"el_c:1----------------- -- ---------------------(Owner and/or Contractor) -----------------------------------------------------(Title)- "I Title ,� ---7n lei__ (Plot 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 I3Y _F_-_ . DATE- - _ _.----•------------------------------------------- REVIEWED BY------------------------------- - ----- ---------------- ---------------------------- -------------------------- DATE---"1V_,----------------------------------------------- BUILDING PERMIT ISSUED------------------------ -------•-----------------•----------- DATE-------c_ Alterations and/or recommendations:_______.__._ ------------------•-----------•------------------------------•------------------ ------••--------- •-------------- -----------------•------------- ----------------------------- -- -----------------------=------- -------------- FINAL INSPECTION BY:------------ - - J Datei� ------------------------------------- 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