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✓ 1 APPLICATION FOR SANITATION PERMIT Permit No. ___��._7o_3.._. (Complete in Duplicate) g y Date Issued Applica-lion 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. JOB ADDRESS AND LOCATION______ �) Owner's Name__. --------------- -- ---- -------------------------- - ----------------------- . Phone------------------------------------ 71 Address-----'- ------ --1---�........ ---9- G -4- j 17 Contractors Name----v0-rel:-'---. C: 9.----- C`�4 - s�------------(/-----•---------•------------------------ Phone-- d Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -j-___- Number of bedrooms __ Number of baths __/___ Lot size ------yam' __ ( _ _______-______________ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table _ .iR ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe[N Hardpan ❑ Previous Application Made: Yes ❑ No [, New Construction: Yes ❑ No FS, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta ante from nearest well-----------------Distance from foundation__._._._________-_.Material____________-__.__----_-________________________- ® o. o}Eompartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- Disposal F' Id: nce rom nearest well - Distance from foundation--------------------Distance-to nearest lot line________-____-__-� ❑ umbe lines---•-------------------------------Length of each line-----------------------------Width of french.---------------------------------- W Type oT filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ e Seepage Pit: Distance to nearest well------)VQ.L11'QDistance from found tion- Q------------Distance to nearest lot line__4'6------- _j (� Number of pits----------- material--&e_,lcc e: Diameter___ ,(_______...Depth ----------- Cesspool: Distance from nearest well______________}Distance from foundation-_.,_._____________.Lining material-------------------------------------- El Size: Diameter----------------------------- --------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.----------------------------------- ------------Distance from nearest building-___----_______________--___--________- ❑ Distance to.nearest lot line----------------------— "" w 4 ---------------------------------------- ----- Remodeling and/or repairing (describe)------------------------------------------------------ = ---------------------------------•---------------••------- - - --------- - 4 ___________________________________________ _____________________________________________________________________________________________________________________________________________________________________.________- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State taws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ e ----- ---------------------------------- ------------ ---. (Owner and/or Contractor) SY� s {Title) ... - `'= -------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD PA TMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ------------------------------------------------- DATE--------- ----- r REVIEWEDBY-----------------'----------------------------------------------------------------------------------------- --- ------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- -- DATE---------------------------------- Alterations and/or recommendations----------f---�-----------1-----------------------------------------------------------------------------------------------•----- -----------------•------- ------- - - ------------ ----------- .--------------- .----------------------------------- --•----•-------------- ------------------------------------------- --- ---- - 9�FINAL INSPECTION BY------ _ Date------ .- LO r� 4 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