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to APPLICATION FOR SANITATION PERMIT Permit No_ _________________ ____ Com lete in Duplicate) -" ( PIo-3d I)ate 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. JOB ADDRESS AND LOCATION-------Xf3_6....----.�------- Owner's Name--------144A_cam---l-----------��£---1 A-I 141---+-------•------------------------ --------------------- -------- ------------- Phone-__"---------------'.." -------------- Address------------------ Contractor's Name +C.lr __. f�_1��5 l " - ' 5----------X�ZZ G--<------------------------------------- Phone---��-l� a 7 ------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. J__._ Number of bedrooms Number of baths __�-__- Lot size -�0�_r)'___��-I___________________�_____-_.-___ r � 1 , •t Water Supply: 'Public system .14 'Community system ❑ Private ❑ Depth to Water Table '_'11d ft.` - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EB Hardpan ❑ Previous Application Made: Yes ❑ No.[E..,..New,Construction:-Yes ® -No ❑ I � ; 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_ #4[Distance from foundation_____1 ------Material._-_ l� ----- [ j No. of compartments----------�L------,-----Size_.S_A-k3 r_W----Liquid depth---- -�..---------Capacity---�'DO-�----- Disposal Field: Distance from nearest well_/4_?Y ._Distance from foundation__,!!____;------Distance to nearest lot line_A__�-____.__- Number of lines y g 0 * �` r `� t, ------------------Len th of each line----- _i> - -----Width-of,trench- Type of filter material_/�-'_AJ1r-f<---Depth of #ilt aterial___.�._�_.__..__._Total length___.__.r�_Q__________________________ Seepage Pit: Distance to nearest well.. p_Me -------p e rom foun a .o_�_____Distance o nearest off=line__ w • , e ----------- ® Number of pits---_11_.__________Lining m terial__S c_��7�`�( .Size: iamete'r� _ ;'.��____ Dept' -.___, P Cesspool: Distance from nearest well----------------- m fo _ ------------------ ming material------------------------ Size: Diameter---------------- -- ---.De th--------------------------------- --__ ---- Luid Ca acit ❑ -------- - _ p -- i q P Y----------------- --------gals. Privy: Distance from nearest well---------------------------------- 4 •est building`---------------------------------------. --------------- ❑ Distance to nearest lot line------------------------------------------------Distance---rom.neare = - Remodeling and/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, State laws, and rules and ieguiations of the San Joaquin Local Health District. t �� (Signed)- ' f, - ,c{ '------------------------- - Contractor) L BY� ` t ( 'l�' -`= = iTi+lei �"• ------------------------ (Plot plan, showing size of lot, location ofsystem,in relationto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - DATE--------------------------------------•------------ --- -- ---- ---------------------------------------------------------------- REVIEWED BY----------------------------- `"" DATE BUILDING PERMIT ISSUED------------- ----------- ----r --- --- DATE------Qd4------------------------ Alterations and/or recommendations---------------(----------r.._.---- .._._. ------------------------------------- F_•- ___________________________L_..A_ ______________.-____ __ r ----------------------- ------------------------------------------- V ________________________________________ _ 3 t _ ______________________________ __________________________________ - ______________________________________________ FINAL INSPECTION BY--------------� #X�l Date----- f "3�'`� � r r SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 10-52 Revised W-2100.