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APPLICATION FOR SANITATION PERMIT Permit No. ------- ....... (Complete in Duplicate) S` Ke MN E R-- Applica+ion 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. "^-1; /O t t N-A",1�-4 w' 19-c�F_ Q JOB ADDRESS AND %dkTION....e72 �1... J. ------------------ Owner s ------ -------Owners Name = £ e -. hon -- Phone - ..� 1- - --------------_---- Contractor's ------- --- - Address-- -•-•-- .. -- --�-�-�-'�---��---- Contractor's Name---- � ------------- ---- = Phone Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel L] Other E]11. , Number of living units: - Number of bedrooms -_- .. Number of baths _4_ Lot size _---. � -_________________ Water Supply: Public syste' ❑ Community system ❑ Private _Depth to Water Tabled _ eft. Character of soil to a depth of 3 feet:; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ AdobeA_.Hardpan ❑ Previous Application Made-A Yes ❑ No E --New Construction: Yes � ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well1/�.�_-_--Distance from foundation_---1-`'-/--._----.Material_-CG- '``''�_____-_ No. of compartments------�------------Size 27_X -------Liquid depth------ ----------Capacity......f -------- Disposal --- --Disposal Field: DistanceM from nearest e1l__A4rZe__Dtstance from foundation----16------:-.Distance to nearest lot line-- --fit.. Number sof lines---.._-- --- . --Length of each line--.-_-- � ` r1 - �- -- ---------- �.�-----.. Width of trench---------- -��---------------• C? Type ori filter material---/3_.___5_P_Depth of filter material --_-_-Total length-------- .-- 7r Seepage Pit: Distance to nearest well_1��U------._Distance from foundation---_-:,- ..Distance fiP nearest lot line--��'-__--- Number! of Pits-------/-------_.___Lining materialize: Diameter-----� - Depth-------- ----r------_-- ;I. 4 1. Cesspool: Distance from nearest well-------------- --Distance from foundation.__--__--.--.----.Lining material------------------------------ ❑ Size: Diameter _.Depth ------Liquid Capacity----------------------------gals. I Privy: Distance from nearest well-.-.__..-.----4 -------_Distance from nearest building - _______--- ❑ M Distance'to nearest lot line.-............ - .- ._ (describe]-------------------- -- Remodeling and/or repairig - -------------------------- ----•--------------------------------------------------------------------------------------------------•--- -------------------------------------------------- ---------------- �Ipi -------------------•-----••-----•---------.----III-----•------------- •----------------------------------------------- ..-- -------------------------------- ------------------------------------ ----- - I hereby certify that] have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s, andrules and regulations of the San Joaquin Local Health District. (Signed)---- -- -- -- ----vw"----- --- ----- ---------------------------------------------------- - - {Owner and/or Contractor] Il' 11�1 ------------------------------------------ ----------------------------------------------------(Title)------ -fes- ` (Piot plan, showing size of 14 location of system in relation to wells, buildings, etc., can be placed on reverse side). �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED�,BY----------------------- y DATE-----�,1---------------------------=--------------- R�VIEWED BY ---------- - DATE---------- ��- --------------------------------------- BUILDING PERMIT ISSUED3------------ 7--------------------------------------------------------- DATE---------------- p _j Alterations and/or recommendations:----------------------- - ---- -- ------. _- --------------------1M---•--'-- ----- ...... --- "-. V_ { --------••---•--------------------------------------------------------------- ...--•- -•------------ -- ---------------- ---------------- ------------------------ -----••-------------------�----•------------------- -------------------------------- q --------- I`; FINAL INSPECTION BY:I-.----- ----------------------" -• n Date- 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 745446 A7W000 12.54