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� 3 APPLICATION FOR ..SANITATION PERMIT Permit No. ..-_7---_ -.-- t (Complete in Duplicate) (P Date Issued -----_/ Applica4ion 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. /45;L `- . JOB ADDRESS AND LOCATION-------_.-______I?6ArW__________________-_______0_--L t - ---------------------- •---------- ------------------------•-----•------------------------------------------- Owner's Name-------_ n C 7 f -�� /a ,~ ----��1-------------------------- - ---�`'--�-.--------------.------- ------------ ----- Phone ------ Address_.........M •- Contractor's Name----------- • ---------•---------------------------------- -- ----------------- ----------------------------------- Phone-_14 to...3---------------- Installation .--_---Installation will serve: Residence [Apartment House ❑ Commercial ❑'Trailer Court ❑ Motel [-I Other ❑ rrr Number of living units: ---I---- Number of bedrooms - -. Number of baths 11 Lot size ------- ------------ Water Supply: Public system ❑ Community system El [v Private Depth to Water Table -------- ft. ---------_ Character of soil to a depth of 3 feet: Sand Gravel E] •Sandy Loam ❑ Clay Loam ❑ Clay {] : Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes V'No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: x (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation__._--------.;------Material ?_Z ti No. of compartments-------------------- -----Size-----•--------------------------Liquid dep? h--1%Y--------------------Capacity..--------------------- 4 Disposal Field: Distance from nearest well----....- _..Distance from foundation-----------------_.Distance to nearest lot line-----_-..---_---- �; Number of lines------------- -------------------Length of each line-----------------------------_.Width of french---------------:---------------_--- Type of filter material------------- --_------ of filter material-------------- -----Total length------------------------------------------ Seepa Pit: Distance to nearest well_-__1.-----___-__Distance fro foundation--_- _f.--.yDistance to nearest lot li e---I�_J__ Number of pits----�.__--.----.-Lining materiQP° ,Size: Diameter-----_3 e.._ z _._---Depth--.-. . '` Cesspool: Distance from nearest well------------------ from foundation.._-1 _____-......1ining material------------------------------------- Size: Diameter---..__ __.-----. ❑ ------- ------Depth-------------=---------------------_1------- ------Liquid Capacity--------------------------•gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ----------------------------------------- ❑ Distance to nearest lot line - ------------------------------------------ - Remodeling and/or repairing (describe)------. - -------- Q - --- ---' --- - -------------------------------- ----------------------------1------------- -----•--------------------------------- ------ ------------------------------------------------------------- t •------- ----------------- f -.--..------•_•----------------------------------------•--•-__----------_._---•-----------......-------_-_.•--------__---_-••----------------•--••----------------------------------------'---"--.----•---•---..----. -- "-.. I hereby certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County �-• ordinances, State laws, and rules and regulations of then San Joaquin Local Health District. 1 --------------------------------(Owner and/or Contractor) (Signed)------- f By:--------------- - ------ ---------------- -------------------------------------• -----------------------(Title)--�?` " -------------------------- (Plot plan, showing ze lot, location f system in relation to wells, buildings, efc., can be placed okfreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --- -------------•------------------------------------------ DATE----- ---- ---------------------- REVIEWED BY------------------- --------- DATE--xr— _�. BiJILDING PERMIT ISSUED -----• DATE------G�-------------------------------------------------- Alterations and/or recommendations:------------- --- ---- -------- •:--__•.. --..--------------------------------------•---------------••---- s l�ln ...---- f � f , !� -. . n ------_------------- ----- --•- --------------------------------- --------------------------------------- tv G'L ------------------------ ---------------------------------•--------------------------------- •----------------------- FINAL INSPECTION ------------------------------------ Date---1015 s j ----------------------------------------------------- -'SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California ES-9-2M 145446 ATWd00 12.54