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APPLICATION FOR SANITATION PERMIT Permit No. _7_7171.__.... (Complete in Duplicate) Date _g( 2, Applica-lion 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 compliant 'th County Ordinance No. 7 IM-10–V- - - I _Z�// JOB ADDRESS AND C,,�T)ON------O-V---- wkl�l----�- ----------- - - ------ -- --------7 Owner's Name------- ---------------------- -------••-•--------•------•1------------------ INOM --- -------- Address--- 2 . .. .. ..... Contractor's Name------ - ------- Installation will serve: Residence jg—Apartment House E] Commercial 0 Trailer Court ❑ Motel ❑ Other 0 Number of living units: /.--- Number of bedrooms-_Number of baths __j---- Lot size ------ -------------------------- Water Supply: Public system V3,–Community system El Private L] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand El Gravel [] Sandy Loam 0 Clay Loam El Clay D AclobeR, Hardpan E] Previous Application Made: Yes E] No 9,_ New Construction: Yes JZ_No D 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._._A/A?-W_Distance from foundation--- ____.__._.Materials_.I IV No, of compartments___ ------------- Liquid depth______L 4 P y � Disposal epth-------- Disposal Field: Distance from nearest well--V091-�. 'sfanca from foundation-----Idr- .__Distance to nearest lot line------ Number of lines----------1 ..14( -------Length of each line-------lite---------------Width of french_....;:_24-A!-. .. ........... Type of filter material___A,- _ _3AeDepfh of filter material_____ Total length----------_45d-Y------------------- Seepage Pit: Distance to nearest well-_,4A�.. ---Disfance from foundation----:;F-A------Dista6ce to nearest lot line-----I�_----_ Number of pits--._(....-----------Lining material__ Diameter- ---- --Depth- -------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-..-...............Lining material------------------------------------ 171 Size: Diameter- - ---- --------------------- -------Depth---------------------------------- ------- - -------Liquid Capacity_ ------------------------- al, Privy: Distance from nearest well____ ____________...____.._._.._Distance from nearest building-------------------------- El Distance to nearest lot line.............. -------------------------------------------------------- ------------------------------------------- ---------- Remodeling and/or repairing (describe)-------------------------- --------------------------------------------------------------------- -----....----------------•-•-----------------_ .------- ----------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------I------I-------------------------------------------------------------------------__-------------------------------------------------------_----------- -- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed)-------•-------- ------- ----------- -------------- ---- ...... ----------- ------I----------------------------------------------------- ---- --(Owner and/or Contractor) By:---- -- - -- --- --rte= — --------e --------------- ---- ---- ---------------------------(Tifle)--,5---- ----------- ------------------- (Plot Ian. s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Z APPLICATION ACCEPTED BY----- -------- - ------ a$, State d �----------- P _=5Z11 - REVIEWEDBY--------------------------------- -_............. - -------------------------------------------------- DATE------- ------------------- --------------------------- ----------- DATE---------- BUILDING ATE----------BUILDING PERMIT ISSUED----------------------------------- ---- ----- --------------------------- ------------------- DATE............. Alterations and/or re lendafions:------- - -------- ----------------- -------------- ......... 72- - ------ ----------- ----------- / -� J�)- ---- ----- --- ------------ ---- --------------------- -------------------------------------- ------ ---- ... ----!---- -- ---C11- -- --- ------ ...... . ... ---------------------------------------------------------------- ---------- - ------------ -------- - ----- - ----- -------------------------------- ------ ....... --------- . .... --------------- _-)...... . ------ --- - ----------------- ------------------------ -- - ---------- ---------------- ----------------------------------------- ------ -------------------------------------------------------------- -------------------------------------- ------------ ----------- ------- --------------- --- ---------------------- ----------- ------------------------------------ ------- - --------------- ------------------------- FINAL INSPECTION BY:_-_ ------------- Date--.----.---.-.. ate.............. --- - - - -------------------------------------- -- - - 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 cs---9-2m 145448 ATWUUD 12-54