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APPLICATION FOR SANITATION PERMIT Permit No. . - '.-0--- (Complete in Duplicate) ; Date Issued _- _o?-�/s.3 Application 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 G �� ---------------------------------------- Owner's Name--------------------------------------- --------- ----------------------------------------- Phone-----� Address-••••-••----••-•••..•---------------•--•-•••-•.••.V�7Yd Contractor's Name ------------------------------------------------------------ Phone------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I-' Number of bedrooms -3--. Number of baths .t_ r Lot size -------- ._Q_"_._'"L1._: _.Q._-._-.___ Water Supply: Public systenx Community system ❑ Private;g Depth to Water Table #!a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I& Hardpan Previous Application Made: Yes E] No 91 New Construction: Yes [I No ❑ 0 -� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pqUc sewer is available within 200 feet.) too Septic Tank: oo Distance from nearest well __Distance from foundation_��_.___._____.Material__te43i ,--- ---------------- tZ No. of compartments " " p r---Size Liquid depth__',Sa _~.---.-__-.--Capacity.-.-%4�Q------ �,ri � Disposal Field: Distance from nearest well-t"- Distance from founclation.14P------------Distance to nearest lot line---- _Q_p`... Number of lines-----I._._---- Length of each line_1_0_'7 ----------_------Width of trench--z_ .`�-y� �_l�s� r fI Type or filter material- ---1�__.-_ --��- �o� Qf filter hma� E- ------/..---Total length/Q._.----------------------------------- Seepage. Pit: Distance to nearest well-I�y'-w------- anc4e�f o'►m foundatio _1-_,J..........Distance to nearest lot line_..__!0.-- i� Number of pits.---0----------------Lining material.r�� ------Size: Diameter----Z-3__ ----Depth-_2..G�"' -'--_--_--_-_-----_-- 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------------------------------------------ El Distance to nearest lot line -- Remodeling and/or repairing (describe): .__.�_ �' t ..�.�._--N,,a /�w.y_!-- .fZ p .-....•.•--... ft...... - ' -� � .. see _ _ _...--•----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, �� nd rules and rtions of + San aquin LocX1Halth District. 9 • (Signed).............. C - - -- ----------x�-- ------ -------- ------- Contractor) BY: ----------•--------------- -------- --- --- -(Title)--- +$ (Plot plan, showing size of lot, location of system in relatio o wells, buildings, ., can be placed on reverse side). FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY_-------------------------------------------------1.k- r� ---------- DATE---------------7 / REVIEWED BY Vv3� l,Y y�3 ---------------------------------------------------------------------------------------------------------------------- DATE------------- 1 ---•------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------•-----------------..................... DATE------------_--- Alterationsand/or recommendations------------------------- ----------------------............................................................................................................... -----------•-•-•-----------------------------------•••-•--•--• ----------------------------------------------------------------------------------------------------------------------•------------------••----•-••----------- -----------------•---------------------------•--------------------------------------------------------------------------------•--------------------------------------------------•----------------------------- -------------------------------------------------------------------------------------------- -------------------------------------- ---------------------------------------------- --------------------------•-------- � j - FINAL INSPECTION BY-------------------------------1---/Z. / ----------- Date.------ �' r�� ---•---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 81North "C" Street Stockton, California Lodi, California Manteca, California Tr cy, California ES-9-2M 10-52 Revised W-2100