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q APPLICATION EOR SANITATION PERMIT Permit No. .7_- .__! .- /Aplicafion (Complete in Duplicate) pDate Issued . _ --- - •----.--- 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 OrciinaNo. 549. n JOB ADDRESS AND LOCATION----------- -----Q/-------I--- &:--, 4------------ ? c ..----------------------- --------------------------- Owner's Name---------------------------------------------- --------- -- ----------------------- Phone------- - F&7—---- Address------------------------------------------------------ seg'-"-e-------------;---------------------------------------------------------------------------- -----------•----------------------- Contractor's Name------------------------------------- I------ ------------------------------------------------------------- Phone-- ... ------ Installation will serve: Residence UK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms Number of baths /-_____ Lot size ------ Z-e_13---.GA- x____________________ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table V-Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L& Hardpan ❑ Q Previous Application Made: Yes ❑ No K 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-7-0-------Distance from foundation_1:2_..___Material____ _ No. of compartments._.__%__...____,.'__5ize_� _� _______Liquid depth_.T _______________CapacitySd___._�____ Disposal Field: Distance from nearest we€i___0.0-_____Distance from foundation---L__Q---------Distance to nearest lot line-_�_______ Number of lines------- --------------------------Length of each line----Z.0-`----«-----.Width of french--A--q., --------------------- v Type or filter material__1_��__1�k------Depth of filter material-------l�----------Total length____ -U-`__________________________ Seepage Pit: Distance to nearest well_!-!_D----------Distance from:.foundation---/.. ___.Distance to nearest lot line----l_Q_410.... IN Number of pits----/----------------Lining material-tt � _---.Size: Diameter _-----J13.......Depth..,2,------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth-----------------------•------------------- ------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_________ __ _____________________________Distance from nearest.building-------_-_.___________________.___.__..._. ❑ Distance to nearest lot line - --- -- ------------------ --------------------------------------------------------------------------------------------------------------- Remodeling ----------------------------------------- ------------------------------------------------------------- Remodelingand/or repairing (describe)----------------------------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws, and rules and regulations of the San Joaquin Local Health District. (Signed, ------------------ { { �___________ Contractor BY:---------------------------------------------------------------------------- -----`------- ------- -- (Title)---C$-�-� j`�-A- 0-12.----- ---------- ----- - - - --- - ------ (Plot plan, showing size of lot, location of system in' elation to wells, b ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED B T--------------------- -------------------------------------------------------------- DATE---3 --------------------------------------------------- REVIEWED BY-------------------------------�— ------------------------------------------------------------------------------- DATE----�� -- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------s-a----------------------------- .. ----------------- Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------••------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------ ------------------------------------------------- ---------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ----------------------------- ------- ----------------------- --------I----------------------•--------------- --------------------------------- ---------------------------------------------------------- FINAL INSPECTION BY:------ J ------------ Date....... __ _C.I _ f ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100