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:. APPLICATION FOR SANITATION PERMIT Permit No. .-3/ `r--- (� (Complete in Duplicate) � Date Issued 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. _ � ��frz✓------------------------------------------- JOB ADDRESS AND LOCATION------- ------ ----------- �=cam f______ .- ------ -i Owners Name ----- &°----- CL— .` "moi_ ?�[L`^ Phone ; Address....................---------------------------- -------------J.- --------------------------------------- ------------------_ Contractor's ------------------------------------...__...-------------------- Contractor's Name--------------------------------J �C GL r o= -4 =-- ----------------------- Phone------ Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1____ Number of bedrooms _:7��Number of baths e--_ Lot size _____ 'b-r-- 4--0-`'_-_ Water Supply: Public system -M Community system ❑ Private ❑ Depth to Water Tab[ _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2( Hardpan ❑ Previous Application Made: Yes ❑ No C}= 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 well_l�_ -_ __Distanc from foundation__!__Q_r.___.Material-___ _�.'_ A No. of compartments________�l`__- Size _._____��_ ___Liquid depth ------Capacity_ p . Disposal Field: Distance from nearest well---&x.►�_Distance from foundation____ __________Distance to nearest lot line_________________ Number of lines____.___________ ______________Length of each line__.c-t9---_______.____Width of trench_ '1________._________ Jam, - it �� Type of filter material___/_�-_____Depth of filter material______3-t9__- ---Width length_____ a_'_____________________ Seepage Pit: Distance to nearest well-_ 4 ( ___Distanc fr m foundation----d� _.___.Distance to nearest lot line Number of pits-----/--------------Lining material _.____Size: Diamete------ Depth____ _ ___________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- F-1 Size: Diameter•-.•----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------- --_Distance from nearest building______________-__________________-_____ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------•--------------------------------------- Remodelingand/or repairing (describe)------- ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------- ---•------------------••-----------------------------------------------------------------....----------------------------------••--_...-------------------------- - hereby certify that I have-preps ed this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. (Signed) !� �(" ; tri' -( 1 Contractor) By:--- --=`----------u- ----- ---=------------ -- -- - - -- - {Title)-- ------ (Plot plan size of lot, location of sys m in relation to wells, buildings, etc., can be aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- -------------------------------------- DATE----------/ , 1{� �------------------ REVIEWEDBY----------------------------------- ----------------------- ------- -------- - -------------- ----- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------- --- ------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ 11 FINAL INSPECTION BYE "A 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 8-51 Revised W-2100