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l / APPLICATION FOR SANITATION PERMIT .Permit No_ ________________________ (Complete in Duplicate) . Date Issued --- �-/_,1_-7 4� Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND :LOCATION... ----- C'' -----------f-�--------------------------------------- Owner's Name---- =. _ _ -----------f..-9_��,+------- ------ Phone------------------------------------ Address-.---.... 3 �`' � Y..-. '' -----------=------------------- - ----------------------------------------------------- Contractor's Name ..._.__... GT-Il1J'-- "---------------------------------------------------•_.---- --•--- Phone._--•---•------------- - a x Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units_ ___�y_ Number of bedrooms I___ Number of baths _J.-` Lot size ----------7-57-x_10_0-_______________________ i Water Supply: Public' system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe„ Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes 0 No [J TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-------- '______Distance from foundation_-1 --------------Mat iai___________________ _. ------- _--_-___. of compartments---_--.--_`_+_-__- ' Na: ----_:Size----itx- :-•-Liquid depth---------- -- ------ -Capacity----19 P--------- Disposal Field: Distance from nearest well__`r________-Distance from foundation- -__��_-.-_-.-Distanee to nearest lot line........ Number of lines---------------(-,-----------------Length of each line_:---------(k0_- --__'..Width of.french---------- Type of filter material- -Depth.of:filter material--------./��---.--Total length,__:____________________----_a_'_--___ umber of its-- -------------------Lining-_ Distance from foundation__..______--_material----------------------.Size: Diameter------------------------Depth---------------------:-------- Seepage Pit: Distance to nearest well_______________ _ ❑ Np _____.Distance to nearest lot line__.__________, _ Cesspool- -Distance.fi�m nearest well-____-_________Distance from foundation___________________Lining -material,------------------------------------- ❑ Size: Diameter-:-,-----------------------------------Depth--------------------:------------------------- _----Liquid Capacity-----------------------------gals. Privy: s Distance from nearest well-__.___________________________________________Distance from nearest building--------------- ❑ Distance to nearest lot line------------------------------------------------------------------------ - ' --------------------------------------------------------------------------------------------- Remodelin and or repairing (describe)-----------------------------------------------------•---- -•-- �c 1n> -► - --- � :----- --- --------- --- ----- ----------------- ------ - ±l-4 �+.�--s- .. l A ----------------------------------------------------------------------- --------- -- --- I h reby c that-1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a and-rules and regulations of the San Joaquin Local Health District. : (Signed _________________________ ____________Owner and/or Contractor .� - ---•--- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). E E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------1----------- --- -- - - ----- ---- ---------- ---------------------------- DATE----------- REVIEWED BY-------------------------------- ••-- ----- ----=- - a ---- -----_ DATE---•-- BUILDINGPERMIT. ISSUED------------- I------------ -------....------------- -- ---------------- = ------------------ DATE------------------------------------------------------------- Alterations and/or recom mendations: _ r 't ----------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- --------------------------------------------------------------------------------------------... ' ---------------------------------------- ------------------------------------------------------ ------------------------------------------------•--- -------------- } FINAL-INSPECTION BY:.--- ----------------------=-------- Date ' " ----------- ---------------------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300.West Oak Street 132 Sycamore Street 814 North "C" Street- Stockton, California Lodi, CaVarnia Manteca, California Tracy, California ES-9-2M ; Revised W-2100