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/✓ J/ APPLICATION FOR SANITATION PERMIT Permit No. 3____.... (Complete in Duplicate) Date Issued _/�al)__�____ Applica+'ion 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_ nce No. 549. JOB ADDRESS AND LOCATIONi-�•yf..?. Owner's Name777 ------- ---•• ------------------------- Phone---------------------•--------•---- Address------------------- ---------` ---- ----------------_----_ ---------------------- --- Phoney----- Contractors Name- -- -- "�. _x��--------- -_--��°T".---- ---� �-�'=---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/__ Number of bedrooms _yNumber of baths ./____ Lot size ------;7Ir ♦ K �o-0_" -- •----------• --------------------------- Water Supply: Public system E] Community system ❑ Private�(]epth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay foam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ®- New Construction: Yesq�]'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeptiTank: Distance from nearest well ------------Distance from foundation_Z-10----------Material____` `------------ No. of compartments---- LS r � rt •. lY Size_ ._--p_ ------ Liquid depth �-�r-.----------Capacity_- ?_ Disposal Field: Distance from nearest well_--S.____Distancerom foundation__��___-____.Distance to nearest lot line--- r Number of lines______._ __-. 'f �----------��-_�� Length of each line-f4------------�,------Width of trench---- of filter material -- _lu ....Depth of filter material____f�______.___-Total length------- ___________________._ Seepage Pit: Distance to nearest well'- -__-_-_Distan4`01 m oundation____��____Distance to nearest lot line____ __-__[�� p / - - ----------Lining materia -/f-- p -------------- Number of its._ __ Size: Diameter__. De tn____ Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material--------------------___________-___ ❑ Size: Diameter------------------------------------.Depth------ ------------------------------------ --------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest we]-----------------------------------_-------------Distance from nearest building__-_______.__._______-________._--------_. ❑ Distance to nearest lot line--- - ------------------------------ Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------•--------•----------------•---•--------•--------------------------------------------------•----------------------•--------------------•------------------------------------------------------------------- ------------------------------------------------------------------------------•--•------- •---------------------------------•------------------------•------•----------------•---------------------------- ------------------- I hereby certify that I have prepared this application and that the work will be done in actor ce with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Loca Health istrict. r DRAY&NIGHT -----------•- a (Signed).... , S..{atic-TarrSore-m---------------- ----------.--- ---- 1.---- - ------------------------ - ---� Contractor) 1206 So.Eldorado HO 2-7046 By:.- o�fCjo�i; till#: -:: Title)--- �- 77 --•------------------------------------ (Plot plan, showing size of lot, location ofsystem In relation to w uildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ---- -- --- ------------------------------------------------- DATE------- REVIEWEDBY------------------------------------- -------------------- -- -- -- ----- -------------------------------------------- DATE-------- --- BUILDING PERMIT ISSUED ---------------------------------- ------------ DATE------------ ---------------------- Alterations and/or recommendations---------------------------- - --------------------------------------------------------------- - --------------- -- --------- ----- - --� � `--- - ------- ---------------------• ----------- FINAL INSPECTION BY:--- - ------- _c---------------------------------- Date----- 1 �4� 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-9-2 MS ; Revised W-2100