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�1 APPLICATION FOR SANITATION PERMITPermit No. ..J... ------..___-. Cmete in Duplicate) ol ) P Date Issued ----- - - -��-�-�---- " i is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica+ This application is made in compliance with-County Ordinance No. 549. ._ JOB ADDRESS ANI, OCATIONJ----------QQ ---------------SQ�4 __.... Owner's Name--------- -_t7f .:.-'- C� r------ --------•--- Phone t9Address-.----- '-a s- = --------- ----- -----------------------------------------------------------------------------------------•--- ---------------------------------------- Contractor's Name------? 6-1r ame-----: �o--/�o a-tem--S s1 1'_- �.[/lC Phone v d�- ° -Z 6 € ----- i Installation will serve: Residence Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: J--- Number of bedrooms _ ___ Number of baths --- Lot size ---- .�X94_�------------------____________ 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 E] No 2 New Construction: Yes [RNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted If public sewer is available within 200 feet.) ptic Tank: Distance from nearest well-____ l�_____Distance from foundation----�O----------Material________:___60�ele1 �. No. of compartments----- --------- ---'Size d ' Liquid depth---------------- - Capacity------------------------ "p ----------•---------- __.___ Disposal field: Distance from nearest weiL4?_._Distance from foundation----Zd----------Distance to nearest lot line_____ Y�_____ ' Number of lines---------------------------- ----Length of each line--------40.--------------Width of trench-------i�Y - .�� -----"- ----` g Type of filter material-_,&4Depth of filter material.._. -----_---Total length _,____---- ------=--- - _Seepage Pit: Distance to nearest well----------------------Distance from foundation---....__ _ Distance to nearest lot line_____..___-.___.. Q ❑ Number of pits!----------------------Lining material-----------------------'Size: Diameter-----------------------Depfih^:=-- ------------------- u/ Cesspool: Distance from nearest well--______________Distance from foundation----------------:_,Lining material-------------------------------------- Size: _____--____--_.____._______________- Siz': Diameter--------------------- -------.......Depth-----------------------------------------------------Liquid Capacity-----------------------------gals. 3 Privy:; Distance from nearest well'________________________________________________Distance from nearest bui4ding_r_.____----_ > ❑ r . . _ ---------------- Distance to nearest"lot Ione' - =- -----'`--------------- -----.... .' I ` P - _ . Remodeling and/or repairing (describe):-------------------------- ...... -•- r --•---=--------------•------ -----------•-------------------- ------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------=--•----------------------------------------------------------------- I hereby certify that I have prepared this application a4fKat 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. �(Signed} o f S- G-�-J---c----r se i !</G -Con tf a'--t0 Y --------------(Owner and/or Contractor) By:----------------------==------------------ �Q'!// �'� x - ----------(Title)---- a/ SrT7o? -�7.------- ---------------- (Plot plan, showing'size"of lot, location of system inrelation to wells, buildings, etc., can.be placed on reverse side). FOR:DEPARTMENT USE ONLY 6 ' APPLICATION ACCEPTED BY------------- --------------- ------------- ---------------•--••-------------------- DATE----------- r REVIEWEDBY-------------------------------------f---------------------------:------- ------------------------------------------ --- DATE--------- -----------------------•--- - -BUILDING PERMIT ISSUED---------------•----------------------------------------------------------------------------------•---- DATE.. Alterations and/or recommend ns: - = ------------------------ 7�� ------ �.P--------- . ,1 � - ---------- --.--k------•------ ---- .r - -- FINAL INSPECTION-BY "" - Cl-(.'- �'+. : - - _- � ------------------ 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 ; IRevised W-2100