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f - f APPLICATION FOR SANITATION PERMIT Permit No. --. _.------. ." [Complete in Duplicate} Date Issued --- _{.�la�3 - 1 Application is hereby made-to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. ADDRESS AND OCATI 1�� --�---- = z.. e � 7 ------------------ JOBi ''� _ x ----- Owner's Name - - Phone Zw � a Address---- --------- -----------=-------------------------------------------------------------------------------------- Ph __ Contractor's Name---=---------6 �- -------e-------- -�� -_--- - ------------------- -------------•-- one__ --�--------------- Installation will serve: Residence_2*' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ?Ot,.er ❑ Number of living units: _-2__ Number of bedrooms _ Number of baths .,�_-. Lot size __: __ _ ______ _________ Water Supply: Public system ❑ Community system ElPrivate� Depth to Water TableQft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan L]Previous Application Made: ;Yes [-] No New Construction: Yes No E] — \\ TYPE OF INSTALLATION AND SPE 1FICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__,7-- - Distance from foundation_ Q-.P----.Material--- _ c -------------- --- __Liquid depth------ -- ---Capacity----------- -------I-- No. of compartments____ P-___-__-_---Size __1_ Disposal Field: Distance from nearest well__ _____Distance from foundation_-Z,�!-:-__-__.Distance to nearest lot line_________________ , A Number of lines------- ----------------4---.-Length of each line________ lJ Width of trench-_- ...- Type of filter -------Depth of filter material__/x111__--_-Total length-------- f 1e - f__.-_.Distance to nearest lot line__ -- Seepa e Pit: Distancelto nearest well_-_ _. a ____-Distance fr m four,"datlon___ __4_-'_ Number�of pits_____ _____________Lining ma#erial_ -r __.Size: iameter----_ `.`._.____-..Depth__-_rte _+___-_________ 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`i'gpairin'g )describe)------------- -- --------I------•---------------------•--------- ------------------------- ------------------------------------------•------------•--------- ------------- ------------------------------------------------'- ----------------------------------------------------------------------------------------------------------- --------------------------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S • laws, !�d 'r es and regul tions of the San Joaquin Local Health District. (Signed) T "- (Owner n `er a d/or Contractor)------------ T -------- .� - �-•------------•------------------------------------------ ----------------------------Fitle�-------- By rQ ide. plan, shaywin size , lot, location of system in relation to wells, buildings, etc., can be pla reverse [Plo# p g DEPARTMENT USE ONLY - - f.1� .-., APPLICATION ACCEPTED BY----------------- -�;-„ --�---------------- ------------------------- ----- DATE-- ------------- .� y ------- DATE-------------------- REVIEWED BY--------- --=--------., "- - ------------------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------ •------------------------------------------ ---------- Alterations and/or recommendations:-=----- •--------------------------------- -- -----------_-------•----------- -----------•--------------------------------•------------------------------ ---------------------------=--------------------------------------------------------------------- -------------------------- ------------------------•----------•---•---- -------------------------- -------=---------------------------------------- -------------- --------------------------------------------------------------------------- io` .20/ !/ Date_ ----•------------------ ----- ----------------- FINAL INSPECTION BYi-------------------------- ----------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streaf 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