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�] � ��} APPLICATION FOR SANITATION PERMIT Permit No. V t./ (Complete in Duplicate) S` Date Issued _-/ -- Application is hereby made to the San Joaquin Local Health District for a permit to onstruct and install the work herein described. This application is made in compliance with County Ordinancg No. 549. JOB ADDRESS AND O ATION..."_ _ -�-`; _ - d --- -- ----------------- --------------------------------------=------ Owner's Name_-____-_ __ r_-►„�.__-_ -- --.- - -- - ------- -------------------------------- ------ Phone Address-------- . ..,,. K.. Contractor's Name -< 0. ----— {Phone --d--- -- ------------------- Installation will serve: Residence Apartment Hpuse-❑ Gommercial ❑ -+Miler Court ❑ Motel ❑ Other ❑ Number of living units: _1____ ber of bedrooms . __ Number of baths -!__--- Lot size ----- a Water Supply: Public system Community syst-j ❑ Private ❑ Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ tel Sand Loam CI Load, Clay I ❑ Y ❑ py ❑ y ❑ Adobe Hardpan ❑ (� Previous Application Made: Yes ❑ No ❑ NewFonstruction: Yes [3] No ❑ xv_ TYPE OF INSTALLATION AND SPECIFICATIONS: __ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank:-7� Distance from nearest well___------------Distance from 'Foundation--------------------Material No. of compartments-_-__ --_ ' / d Ize---- - Liquid depth--------------------------Capacity---------------- ----- Disposal Fielde Distance from neares� well n1 Distance frern ougdation_ - � r� d _� Distance to nearest of line__'--_____-_.. L i�'� Number of lines-_-__X Z _,x-- Length of ga' b line'__ L� ,e "Widtrench_ th of - ✓�- -------- Type of filter material _d `,_ �31311I+I..aG..- Total length------- ------ ----- ----- Seepage Pit: Distance to nearest well----------------------Distance froi5 foundation--------------------Distance to nearest lot line----------------- , ❑ Number of pits----------------------Lining material-----------t-----------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance fro foundation-_?-_______��------Lining material----------------------------------- El Size: Diameter--------------------------------------Depth--------o --------------------- m = Liquid Capacity-------- gals. Privy: Distance from nearest well----------------": `__:---__DistancE from nearest buildin ❑ Distance to nearest lot line g ---------------- -- Remodeling and/or repairing (describe):._____- -, ---- Zz�_ _ � s ----------------- ---- ---- ------------------------------------------------------------- M. } ------------------------------------------------ -------------"--- ;-----•-------- ' ------------------------------ I hereby certify that I have prepared this application and that th work will b4 Bong in accordance with San Joaquin County ordinances, state Jaws, and rubs ajrd regulat' ns of the San Joruinocal Health District. f A K (Signed)_ � ' :- �'lt _ =! --=-- ------ " 44� -� - ---`—- -- - - _Ow rand Contractor) By: x :------------------------- - ------ -- -- -- -------------------------- - (Title) ' • '~ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ."FORD ENT USE ONLY APPLICATION ACCEPTED BY-------_--------- -- ---- --------------------------------------- DATE ------- ---------------------------------- REVIEWED BY----------- DATE BUILDING PERMIT ISSUED__-_-_-____- -- -------------------------------------------------------------------------- DATE----------- Alterations and/or recommendations:___--_-_-_.-_.-_---__________________"___ --------------------------------------- --- --- --- --- - ---------------------------- FINAL INSPECTION BY:----------------- ______________ Date-----------------� _-!- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" ` Stockton, California Lodi, California Manteca, California Tracy. Califorw ES--4-2M 8-51 Revised W-2100