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f� t APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 1-70- Uinstall the wXerein described.o Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct ao This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.._--- -74� ----------------- l Owner's Name------' /) •----------- --------- Phone. -- ------------- Address'3 V ------.-------------------I——•----------------- --------------- iG Contractor's Name.---t--------------------------------------------•------------------------------- Phon& Installation will serve: Residence k—ATartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other E] - Number of baths -�_•_. Lot size -- �?---------�_--L-2$ — ----------------- Number of living units: _�____ Number of bedrooms _ _ _ Water Supply- Public system (4 -Com, system ❑ ' Private R j�pth to Water Table J-� ft - F � Character of soil to a depth of 3 feet' .Sand ElGravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan E] Previous Application Made: Yes ❑ No v'—Flew Construction: Yes 4 --Wo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank, or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well_ a______Distance from foundation____-_b4___._.Materiai---------------------------------------------- __. ` .No. of compartments----------------------Size--------•-----------------------Liquid depth-------------------------_Capacity----------------f----- - 11 Disposal Field: Distance from nearest well-6�� r /_�__` .___.--Distance to nearest lot line_f� to __ ____-Distance from foundation_ _---•--•---•• Number of lines ------i_---- - _-�--. Length of each line----,-Q---------------Width of trench --- `-''.------------------ --:-Depth of filter material___:- __`__.__.__Total length______c - �_-______________:____-__ {(j T e of filter material__��--°.__ - p Seepa e Pit: Distance to nearest well___--------- _.__ ___Distance one foundation__ ---AA -------- Distance to nearest lot line_______-__.__ f Number of pits.._.___,r___.----___Lining material. t'cr ----_-Size: Diameter_-_3.?----7`Depth----2,_C'?------------------ I N • Cesspool: Distance from nearest well ----------------- Distance from fou ndatio`'-.hikingm tenaL=,---------------------------------- ElSize: Diameter- - 1-----------`,--------------- -Depth ------ -----------Z------------------------- --- -Liquid Capacity. - -------------- Privy: ••---------- Privy: Distance from nearest well ------------------ _____________Distance from nearest building___-___._ .'_______________,_______--.- l ❑ d f -------------- --- ----------------------------- --•--------- Distance to nearest .lot line �------=----4•"-"------------------ ---------- ----- - - --tb'--------••--------- ' l y r Remodeling and/or repairing (describe]_____________________________-__.__._.___.__.___________ -------� = y 1 = � I hereby certify that I have prepared this application and that the work will lle done in accordance with San Joaquiri:.C,ounty ordinances, Stafllaws.4ndd rules regulations of the San Joaquin Local Health District. ! .� ctor) ------ (Signed --._ ks-i=rv_r----------------------=----- -----•-(Ti+lel '(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can,be„placed:-on reverse side).- FOR ide).FOR DEPARTMENT USE ONLY t I � DATE ----- APPLICATION ACCEPTED BY ---_ BY ---------------------------- ------- - ! ----- -------------------------------------- •- DATE------------------------------ REVIEWED`. --------------------------- DATE --------------------- ING . ��-`--------------- AlterEat ons and/orTrecommDendations:-•------------------ ----------------•---------•-----------------•----------- -----•------------•---------------------------------------•-•-•------------•---------------•- ---- i -------------------------•------------------------------;-----------•------------•-----•----------•---• ------------------ ---------------------------------------------------------------- -----------------------------------------------.--------------------------•------------------------------------ ------------= - -------------------- � FINAL INSPECTION-BY7-------,V - ---�Date- .-f_.... ------- { :- -- 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 rr9—?M ; IRevised W-2100