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V APPLICATION FOS. SANITATION PERMIT Permit No. ....----- 1,�� (Complete in Duplicate) pate Issued (Pill Applica�ion is herebym'ad 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. ------- V --------- ----- ----------- -------------- ---------- JOB ADDRESS Loc, 1 71 N...--- --- - ---- ------------------ Owner s Name------ -- ---- -------- -------- Address ------------------------------------------------------------------------------------------ ------------------•-------- -----� -------------- �-------------------- ' ------- ---- ---------- - Phone.�.-= -��---~-3-�-s-S - = - --------------------------------------------------- Contractor's Name..__:_. Installation will serve: Residence [Apartment House El Co El Trailer Court ❑ Mgtel El Other ❑ Number of living units: ._I.--- Number of bedrooms ..Y- Number of baths ->(.--- Lot size .�..r 1-.- - Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table`_'*'��- ft. Water ❑ y Adobe Hard an Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Cla ❑ p ❑ Previous Application Made: Yes ❑ No New Construction: Yes Eue�F4o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic 10: Distance from nearest well-.- Distance from foundation.-_...............Material-_.----- Capacity._.... -- No. of compartments. , - - ---- ----Size------------------ ------------- Liquid depth.... Dispo�6: Distance from nearest well --- ---------.- Distance from foundation-------------------Distance to nearest lot line..-_-:`.--------- Number of lines------ ------ ------- Length os each line----------------------------- Width of french----------------------------------- Type of filter material- .--- ----------- --.Depth of filter material..----tter_ -- . -------- Total length---------------------------- � yy.1V: C..�_- __Distant from foundation. DistWce to nearest lot lip ---4—--------- Seepage Pit: Distance to nearest well_A,$ Size: _ ._-- ------ -Depth.-.--- ---------------- Number of Number of pits.-..�--------- - ----Lining material-.- -- - Distance from nearest well.................Distance from foundation. _.-------- ----- Lining material-_._._-..- _.-------------------- �+ Cesspool: -_---_Li Liquid Capacity gals. c Size: Diameter--- - - - -- --- .Depth------------- ------ - --- �- - - - El Distance from nearest well------------------ -------- Distance from nearest building-_--------------------------- --------- Privy: Distance to nearest lot line.. ------z- --------------------•--------------- - - - ----------------------- ❑ -„ ,:---- ----- C�. - - Remodeling and/or repairing (describe]:--__ '.- ------ --- ---- ---- --------------------------------------------------------------------•---- ----- - ------- 3 ------- -her----- --- -------------------------------------------------------------------------------------- ----------------------- 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 Joaquin Local Health District. Si ned ---- ---------- ---- --------------------------- ------ - - - - --- ------------(Owner and/or Contractor) . . . ( g ) = -------- L'� - -- - --- ----------------------------------- y:--- --- � - (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be laced on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- ---------- DATE-----�-------------- - -----•-- -------- - BUILDING PERMIT ISSI�ED---------- ---- --------------- ------------ --- = DATE-.. ..DATE---- ...-- .- REVIEWED BY------ - --- -- --- -- -- --- -- -- ,.— _ -- ----- - -------------------- -- ------ --------------------- Alterations and/or recommendations:.._-._- _- ------- ------ - -.------- _ ��------1____.1----- - ------------ � ----- �. . � = ---------------- --------- --------- -- - G ----- ---- . - _ -.. � tt 4 Date.- ----l.- ----- J -- — FINAL INSPECTION BY:..---- ---/ .- � SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C” Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y. ES-9�2M 145446 PTY -o 12.54