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APPLICATION FOR SANITATION PERMIT Permit No. ..3_...`�c (Complete in Duplicate) Date Issued _3________ Application is ereby 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......... v----- -ea Wit_---- , - •-------- ------------------------ ------ Owner's Name-- --- --1--qz ,6 a. _ ----— Phone -------------------•-------------- Address.................................... -- ..X{ --- /mss -- •- -•-----•••--------•---................................... - ------------ Contractor's Name........ �__ __ _�__ d-� --- - J � W --=-/---- -- -��--�'=��-'�'�__ Phone---.-`--- __._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ N er of bedrooms __ _ Number of baths .1___ Lot size ......7��/Y__-�.•�-� Water Supply: Public system Community system ❑ Private`❑ Depth to"Water Table--.17 ft. Character of soil to a depth of 3 feet: Sand ❑ avel ❑ Sandy Loam lay Loam ❑ Clay ❑ AdobeHardpan ❑ 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 01 Tank:.-/, Distance from nearest well _________Distance from foundation--------------------Material ______-_________ .._ --------_. �. No. of compartments---- -----------------Size--------------------- -- -----Liquid depth------------ ----------•-Capacity----- DispTosa'�Fiel Distance from nearest well-----------------Distance from foundation---------------_....Distance to nearest lot line_______________ dNumber of lines --------Length of each line------------------------------Width of trench------- ---- ------ Type of filter material_____,�__ _ Depth of filter material____----------- --------Total length,.__._._._:__________________._____.____._ Seepage Ni Distance to nearest wellz-Vd Distance fro fou ation......-- / cS Distance to nearest lot line__�j _______ Number of pits----�j1,L______Lining material__1Size: Diameter_______ _ _________De tn__- S/. .3' p ----------- 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 -------------------------------- F-1 Distance to nearest lot line- ----- - Remodeling and/or repairing (describe):-_---- ------ - f -------- --- ----------------- ------------- , e ------ ---------- -•-•----• ----- I X-7 - --- - --•--- •••-----•--------- ---- --------------------------------------------............................. ------ 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 J aquin Local Health District. (Signed) 0 -6 — ' Si 9 )- ---------- - -- (Owner nd/or Contractor) By:------ ---- t:—. --+--•••--6�6.� -------- ----- ---------------------------- --- ---- Title (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 BY------ ------------- DATE--------- _____ ____________ --------- DATE____ -- -------- ------------- --------------- REVIEWED BY---------------------------------------------- -- ---------- -------------------------------------------------- ------- DATE _ ------- ----•- BUILDING PERMIT ISSUED................... _________•.---__ DATE---.__..---------__---- Alterations and/or recommendations_________________ ---------•----------------------•------•------.-----•-----•-------•-----•-•----------------•---•-____-----••----•- ----- 7 1� FINAL INSPECTION BY:-------------___:. �` iwF_ Date__.___.___-.2_ �J 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