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" APPLICATION FOR SANITATION P Permit No. . �_------- (Complete -- - -- ----- -,, j (Complete in Duplicate) Date Issued pplica*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. 1l S— 2,7V—o JOB ADDRESS AND LOCATION__ 41,eheF�lplll A"P11 Owner's Name_ 1�-Q--�Ip _._L - ---- IF�fLi'il► Phone Address----------- * 4 $ .'---- -------- --------------------------------------------------------- ----------- Contractor's Name------------------------------ ----------------- --�-- -•-------------------------------------------------------- Phone-- ---knfd� Installatio -fP-_JFdo-�?.- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ----- __ Number of bedrooms ________ Number of baths r__ Lot size _�l - _________________'*__-,___________ Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table 147t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan q . Previous Application Made: Yes ❑ No 54 New Construction: Yes Pd No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if(public sewer is available within 200 feet.) Septic Tank: Distance from nearest eIII ____Distance from foundation-1 Q_`0-----.Material----- _ �� 1 ---------- ----�- No. of compartments— -__Li Liquid de th.__ __. _--------- acity eo '6 Disposal Field: Distance from near st wef 149-'..-Distance fro�faundation__ Q�____-Distance to nearest of line--------___- Number of lines________1-1 _ Length of each line_ S.C.�_ ___ Width of trench.__ �/� Type of filter material-.- „-Rk_____Depth of filter matena4____`--__-------Total length_ _______________________ See age Pit: Distance to nearest well__ -440- _,Distanc fr m foundation_ _a _____.D Lance to nearest 1 t line-- -!!n 9a ii , i Number of pits --- material_____. _ -___ ____.Size: Diameter____ .-_-_____.Deptn__Ia�__________.____._ Cesspool: Distance.from nearest well-----------------Distance from foundation--------------------Lining material__._________-_____________.__.-_____. ❑ Size: Diameter----- ------'"”--------^--•:_"__-Depth------,----- ---------- -_�Licluid Capacity-------------------------- Privy: ----------------------- gals: r- -- _ - Privy: Distance from nearest well------------------------------------------------- from nearest building----------------__----_________________:_- ❑ Distance to nearest lot line-----------------------.----------- - - H Remodeling and/or repairing [describe] /^,�' _Wss"'�" f �f ------••---- -------------------------------------------•-----------------------------------•---------•--•--------------------------------------------..----•------------------------------------•-------------------------------------- I herebyrtify that I have p epared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, a rules d regulations of the San Joaquin Local Health District. I - , t (Signed)-------- ---------------- -- ---- ---- ----- -•----------------------------------------------- By: --------------------------------------------- ( ontractorj By:-------------------------------------------------'------------- - ---------------(Title)-- i-m-LI -0�---------------- (Plot plan, showing size of lot, location of syste n relation to we , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------- ----- DATE `- ` ' .. ------------- "� REVIEWEDBY-----------------------------------------------------------------------------------------------------------------•----------- DATE---------------------------•------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------•----------------------- DATE----------------------------------------------------- Alterations and/or.recommendations:----------;---------------=--------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------•---------- --------•-------------------------------------------------------------------------......-------------------------------------- --- ------------------------------•- •---------- FINAL INSPECTION BY:.:--=__._ -----------------------------------------------="--- Date------------ ----------------------- -- ------------------ 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 . ' Revised W-2100