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` APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) 5�/ 3' Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. e This application is made in compliance with County Orcin ne No. 549. JOB ADDRESS AND LOCATION ____._./ r!-1.12.�--- " Owner's Name---------- G4_`s-�---- fone__ •------------ - - --------- --------------------- Address---------- f'-- --------.-------- --------------------------------------------------------------------------•-•-•-•- -="= Contractor's Name.................... --- • - ---------------------------------------------------------------------•----------------------- Installation will serve: Residence 1* Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo I Fl Other ❑ Number of living units: / Number of bedrooms Number of baths Lot size 46_`c- ._ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table to ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay LoaMX ]� Clay ❑ Adobe❑ Hardpan Previous Application Made: Yes E] NoX New Construction: Yes X No E] TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well_____Q----Distance from foundation_.-___[V........Material_________ No. of compartments __ _v(_.Size_____ • © t __ �y P ------- ��----- �-x-�---�-�---Liquid depth----------=�=----�3-----CapacitY-----C�- --�Disposal Field: Distance from nearest well------ _ Distance from foundation------_(______ ___.Distance to nearest lot line...15.......... Number of lines___________________ �t_ Length of each line------------�lU_______.Width of french..____.___ � _. �...... Type of filter material____1 / _ ___Depth of filter material------L- -A___Total length--------- _G�_______-__�__ I tT SeepagePit: Distance to nearest well----1_-_________Distance from foyndation......�___ _.Qistance to nearest lot lire Number of pits---------I_-_ _Lining material_____ le ..size: Diameter...... ------Depth---------1 - _____________ -- - Cesspool: Distance from nearest well_________________Distance from foundation-------------------Lining material____--------------------------- , El Size: Diameter--------- ----------------------_---Depth--------••-•----_ --------------------------------Liquid Capacity.......... ..............gals. t Privy: Distance from nearest well---------------------------------------__________Distance from nearest building_____ Distanceto nearest lot line-----------------------------------------------------------------------------------------------------------•--•---------•--------•--••---•--•• _ a Remodeling and/or repairing (describe):-------------zn�................................................................------------------------•••-•---------................. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,2ate laws, anj rules and gulations of the San Joaquin Local Health District. (Signed) --- -•---••--•------•--•- Owner or Contractor By:..................... -.-- ---------------------•----------------------------------- •---.._.. ......(Tifl (Plot plan, showing siz lot, location of system in relation to wells, buildings, etc., can be ' ed on reverse sid�'-'O_" `FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- = ------ ...t t.?t '-------------•-_._ DATE------ --•-- REVIEWEDBY-------_------------------------------------------------- ----------------------------------X----------------------- DATE. BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..................----------------------------------------- Alterations and/or recommendations----------------------------------------------------------*......................................... ._..... -------• >............................. ----------------------------------------------------- -------------------------___.................................................................................................................................. ----------------------------------------------•--------•------------------------ .......---------------------------------------------------------------------------------------------------------•------------------•-------- ---------------------------------------------- --------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- r FINAL INSPECTION BY:...... --. , SAN JOAQjlN LOCAL H0kLTH,DISTRICT 130 South American Street "': 300 West Oak.Street 132 Sycamore Street 814 North ",C" Street f Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100