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- N 1 Permit No. ?A_. APPLICATION `'FO"R" SANITATION PERMIT _ . { (Complete in Duplicate} Date.lssued` _`r___3Y 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. .. -------- JOB1ADDRESS AND LOCATIO-/N�------ ---- Owner's Name. , A/fir Phone d-: rt, ---. ------------------------------------ / e Address----------------------------------------------------------------------------------------•---- ----------------------------------------------------------------------- Contractors Name----------------- ----------- -------- - ----------- ------------------- --------------- - ------------------------------------ Phone----------------------_----- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s Number of living units: _ ___ Number of bedrooms ___1"__ Number of baths J----- Lot size .....�_4___�------2--,60-------------------- Water Supply: Public system ❑ Community system ❑ Private �to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [jClay'Loam p Clay ❑ Adobe pan-[Q Previous Application Made: Yes ❑ No J lew Construction: Yes ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well�__ j' Distance from foundation----1_ _.------ .Material---- ----� lU€ } � . No. of compartments---------=.b '-_-___---Size-- -- - ----Liquid de ______-.11 (t ----Capacity----(- ( - " Disposal Field: Distance from 'neares well___�__S'___.Distance from foundation______� Q_____.Distance to nearest lot line____ ' Length of each line------_-�-0-----------Width of trench---------------- � C Number of lines--------- ---- ---------- - - W' �' ---"----------- Type of f Iter material__ Depth of filter material_.___ __�t-_____-Total length___________ ___Q-__'- -------- Seepage Pit: Distance to nearest well-----_----------------Distance from foundation--------------------Distance to nearest lot line______________.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: _ Distance from nearest well _----------- _Distance from foundation--------------------Linin material-------------------------------------- � �De th! �----- T = ==w Liquid.,Capacity-=— Size:'Diameter P -- - } Privy: Distance from nearest well - --------------------- ---------------------Distance from nearest buildingl_ __-____________------------- " Distance to nearest of line_.___,,, _________________ -------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)___________ ------------------------------------•---------------- ----------------- ------------- ------------- --------- ---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � -------------------------------------------------------- (Owner and/or Contractor)Si ned G Title tr (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' -------- DATE--------- --- -`--'--�--- ------ APPLICATION ACCEPTED BY--------------------------- ------- ---------------------------- REVIEWEDBY----------------------------------- ---------------------------------------------------- ------------- DATE ;. .BUILDING PERMIT ISSUED------- -------------------------------------------- DATE----------- Alterations and/or recommendations: ' Vis. • /�'- I ---------------- rt� 7 i,� •'D ,� ---------------------------------------------------------------------------------------------- -"-"-4,.-.--- ----------------------------------------- - -- --------------------- • FINAL INSPECTION BY:--------------------- --------=--------------------------------------- Date----- ------------•--- - SAN JOAQUIN LOCAL HEALTH DISTRICT k 130 Soufh American Streef + 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100