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APPLICATION F Q OR SANITATION PERMIT Permit No. U r (Complete in Duplicate) Date Issued ----/ �_ A licafi' ion is hereb made to +h pp y e 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 A L CATION__ _.__ - -- -- --------- ------ ------- -------- ----------- -------- ----- --- 3� y ,. /, Owners Name__-- 'G 1 d _______________________________________________..___----------------------- __ ---- ----------� ------------- ---- --- Phone---�--r---- �`-��`- -------- Addres - r ------------------------------------------------------------ ------•-------------------- Contractor s Name 6d=-`- rte Phone Installation will serve: Residence si Apartment House ❑ Commercial ❑ Trailer Court ❑ lylote�l ❑ Other ❑ Number of living units: ---1--- Number of bedrooms _ Number of baths /___- Lot size ____ =_ _--__`-- ��i-(,_-`-----------------__- Water Supply: Public system [/ Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: San Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe [Hardpan L] '-i Previous Application Made: Yes ❑ IN New Consfruction: Yes [v No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+. /Tank: t nearest rQanffo - ion---!__ ----`---- Mater* Noof compartments ts ., - ��.- - ty_ze _zid t--------- - --- Capaci _Xt Disposai Field: Distance from nearest well---__."'"'._-___Distance from foundation____ - __ .____Distance to nearest lot I- le1:�___- -_--- Number of lines_____________ '____ -Length of each line___-- -- r 4�� 9 �--.Width of french ------------ -------------- Type -_--- ` ------ ------ Type of filter material's--___ • ___Depth of filter material-------/_ Total length-------- ---i . -__..._--- Seepage Pit: Distance fo nearest well-----------------_....Distance from foundation--------------------Distance to nearest lot line__,_ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth_..___.._._____----______,______ -_ ----------- Cesspool: Distance from nearest well-----------------Distance from foundation______ ..____-----.Lining material----------------------------------- 171 Size: Diameter------ --------- --------------Depth----------•-------------------------------- - --Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------- ----------------------Distance from nearest building_____-____._____._________ El Distance to nearest lot line_____________ - - - --------------------------------- Remoclsig and/or repting (de tribe) ----------------------- ___ 1F ---------^--------------------- ----------------- •-------•--------------•-------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stale law , and rules and regulations,of the San Joaquin Local Health District. (Signed)---- , = = 7 ----------------------------------------------------------------------------(Owner and/or Contractor) By: --------------------------------------------------------------- - -- ------ ----- -- ---------------- 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' _ i. ------------ ----------------------------------------------------------------------- DATE------ REVIEWED BY - DATE----- - � BUILDING PERMIT ISSUED ____5 - -- --- ----- Alterations and/or re commendations:_ y' +, 1 .' �� i - -------- --- ----------------- ---------------- --------------- ---------------------- _________________________----------------------------------- 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 8-51 Revised W-2100