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CM, itA41 ' APPLICATION FOR SANITATION PERMIT Permit No. .__.G7..Q.4.--7. 1794 1 (Complete in Duplicate) Date Issued Applica+ion 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. JOBADDRESS AND L CATION------------ E3 ------------- vb_--------- -------....-----------------=----------- •-------------------------------------------- Owner's Name----- � ----------------------------- -------------------- -------- ------- Phone Address �� - -�- ----••-----•----------------------------------- - -- -- ----------------- Contractor's Name ^------------------- Phoned �* ¢ A Installation will serve: Residence M-.. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ = Number of living units: _1____ Number of bedrooms --. Number of baths __.— Lot size ---------------------------------__ . ------------------------- Water Supply: Public system :Z Community system ❑ Private ❑ -Depth to Water Table ________ ft. Character of soil to a depth of 3 feet:'' Sand ❑ Gravel ❑ Sandy Loam ❑, Clay Loam El Clay C1 Adobe W Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Disfance from near est well-------------- ---Distance from foundation--------------------Material.....--.____.__.___:_____.___--___-_-_________- ❑ compartments------ ----------- ----Size--------------------------------Liquid depth--------- -_-Capacity------ ---------------- Disposal Field:` `Distance from nearest well.................❑stance from foundation---------------------Distance to nearest lot-line______.____._._.. ❑ mber of lines---••------------------------------Length of each line------------=----------------.Width of trench----------------------------------- Type of filter material--------------------- of filter mater' !_----------...--------:Total length--:.____.___________________._.__________ -- "� i Seepage Pit: Distance to nearest well._._frL-�T�s--D.istrn �rr mfours t n_____ A__._..Distance.to nearest lot line___i&L?s. umber of pits--__I..______._.___Lining mate .fl ¢e:.Diameter.___L .,.__._Depth___ r___...____.- `lVCesspool. Distance from nearest well_______________-Distm-foundation.___..._-_._.._...Lining material__.-------------------- _____________ ❑ Size: Diameter------------------ ------------------Depth----------•----------------------------------------Liquid Capacity....=-----------------------gals. '1\4 , Privy: Distance from nearest well-----:.-------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line_______ _________-------_------------- - Remodeling and/or re ai Ing (describe):------------------ ------------------.------ �•�77��---- ----------------•--- ---------...- ,� �- --------------- , - r T' - ---_-. -------------------•-------•---------._-_-..-.----._..----•-•---------------.------------------- ----------------------------•-••-------------•-•---------------------------------.---------------------------- --------- I hereby certify that I have prepared thin application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed)------- ----�" „ ` ------L----------- ------ --------------------------------------- ------------------------(Owner and/or Contractor) 13 ' G -- -- - --- - --- -•------------(Title)-----rte--- --�--:--;--------------------.---- Y (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 APPLICATIONACCEPTED BY---- ---------- ------- ------ ---- ------------------------------------•---------------- DATE------ ------------------------------------------ REVIEWED BY-------------------------------------- ----------- °------ ....... ------------------------------------ --------------- DATE--- ----------------------------------------- ') BUILDING PERMITISSUED---------------------------------- DATE------------- -------------------------------- Alterations and/or recommend tions:...................___ .._ _ ,- ` �-� � - ---- --- - - - ---- ----- r - ---. . ---- ------ - - --- ------------- -- ..w } -{ FINAL INSPECTION BY:,-- .� `. ----------- Date.....__.l.--' - . .r_ _<S - SAN JOAQUIN LOCAL HEALTH DISTR T 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street lr_. ' tom Stock+on, California Lodi, California Manteca, California Tracy, California r- �s ES-3 145446 A7WOOD.