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S'- L/ APPLICATION FOR SANITATION PERMIT Permit No. in Duplicate)��` (Complete P ) Date Issued ..... �-•._-/.Z-`3 Application,is hereby made to the San Joaquin Local Health District for a permit to construct and install t e ork herein described. This application is made in complianc it ounty Ordina ce No. 549. �6 JOB ADDRESS AND LOCATION------------ -- -- ------- �?``�` --tz------ --------- Owner's Owner's Name........................................ _ ------r - b Phone.... --------- Address........................................................ --------Address----.....--•----•------•--------•------...--••-•--------=__fit =ate-- ------ Contractor's Name-------------------------------------i� �.r- ---------- r---- _-- -------------------------- Phone----P.7 Installation will serve: Residence 2( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms ---Y Number of baths -_-_Z. Lot size •... .......�•-�.-t?._'�.......... Water Supply: Public system E] Community system [IPrivate, Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9- Hardpan R Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! IlcDistance,from nearest well-______-__---__Distance from foundation....................Material__.___--___-.-:.---._____--__._-.--..---_____--. - -� No. of compartments•------ -----------•------Size--------------------------------Liquid depth_--•----------------------Capacity---------------------- Disposal Field: Distance from nearest well. 49 Distance from foVndation._/j 'r_..Distance to nearest lot Number of lines........[.....___. Length of each line______yQ_'"__-.--___-.Width of trench,._`_AP_------------------------- Type ?/.'`............... Type of filter material_-__�__�+-__f��_Depth of filter material......l-c�.........Total length___.__Y',Q-�_____________•_-__------_ Seepage Pit: Distance to nearest well-----��___D---------Distance fr m foundation......-r1d ...Distance to nearest lot line_-__- P 1 9 I 3-. ---Depth--------;__, - ---------- -� Number of its_______ ______________Linin material. __ ._�___.Size: Diameter.._____. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____-_-.___-__-___-._-_._-___-______ Size: Diameter.-- ----De th--------------•---------- - -------- ---- Liquid Capacity --- - -is Privy: Distance from nearest well--------------------------------------_----------Distance from nearest building__:.- ------------- __._:-_ __. -❑ Distance to nearest lot line------------------------------------•------------------------------------•---------•-•-------------•---•-------•----- ------ Remodelingand/or repairing (describe):-•- -------------------------------------------•-----------------•••-•-••------•-----------•-•-------------•-----------•---------------•--------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S and rules and regulations of the San Joaquin Local Health District. ZL(Signed) .------ ... =` -a= —�'------ ----- - --------- ------- ---------- ------------------ +8a11r or Contractor) BY: ----------- = Zg -----(Tit e)--- ��/ t ! '(Plot plan, showing size of lot, location of system in rely to wells, builds, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Q __•_____________ __ _______________ DATE- '-_--_---___. REVIEWEDBY ----------------------------------------------------------------------------- DATE---- ----------------------- BUILDINGPERMIT ISSUED----------------------------------------------....................................................... DATE........... e----------------------------------------------- Alterations and/or recommendations _ ______________ p � ------------ ------------------------------------------- - ------- --------------------------------- ---•-----------•-------------------------------•--------------•--------•-----------------------•------•-•-------------------------•--•-------------------------.:.---•- r 1� --------------------------•-•---------------•-------- --------------•-•.-••--------------- ......--................................... --•-----------•---------------•------•-------•- --••-------•-------•----------------------------•---------•---•-----------••-•----•--••-- FINAL INSPECTION BY:........� zI ..----••- �_ Date------ -- - 3 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 10-52 Revised W-2100