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APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) Date Issued ._?1Z.0,4 Applic&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 Ordinance No. 549. JOB ADDRESS AND LOCATION_'�. __Qfn: * Owner's Name------------762-r-ri �4 I _x---------- ---------------------------------- - ------- ---------------------------- Phone--f ----- '- Address---------------- Z, Contractor's Name------------ ------------------------------------- ---------------- -------------------------------------------- Phone..----------- --------------------- Installation will serve: Residence 2"Apartmerif House D Commercial E] Trailer Court [-] Motel 0 Other F1 Number of living units: _/---- Number of beclrooms-;$---.. Number of baths Lot size _/420 " I ig X-1 _j�,-------------------------- Water Supply: Public system E] Community system El Private Depth to er Tabiec3/,,__ ft, Character of soil to a depth of 3 feet: Sand Ej- Gravel [-] Sandy Loam ;;C'51�ayLoam E] Clay E] Adobe C] Hardpan ❑ Previous Application Made: Yes E] Noew Construction: YesNo E-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public`sewer is available within 200 feet.) Se tic Tank -Distg-N6-fro-i-fi -�-ea—rWweIj: s ei n c e 50—m—r-1-75--n-I—on ,; oun a i M ial No. of compartments- --;2------------------Size_.'_*j001__y .0--Liquid depth-_ Y--- ---------.Capacity-/ Disposal F;eld-. Distance from nearest well Distance from foundation -I jDistance to nearest lot line- r Number of lines------ ------- ---- Length of each ----------- Width of french. -.9-K.*` ------------ ------------- o of filter material..../8-_'__" Total length------I Type of filter maferial-S III- - ------ -3.4 Seepage Pit- Distance to nearest we;l- --------------------Distance from foundation-------------------.Distance to nearest lot line--_------_.-----_ El Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--- ----------------Lining material----...----------_--_--.- ElSize: Diameter--------------------------- ------:.-Depth--------------------------------------- ------------Liquid Capacity-.-. ------------------ 7_ - Z: ------•--gals. Privy: Distance from nearest well...- ------------------------------- ------------Distarice_ r0n)-ftiares+7building_.-. - I ❑ ------------------------------------ Distance to nearest lot line - -------------------------------------------- - - -------------------------------- Remodeling and/or repairing (describe):--------- ---------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------ --------------------------------------------------------------------------------------•---------------------------•--- ---------------------•-------••------.-.-..-....----------•---------------•----.....-----•-------------•--------------------------------•---------------------------------------------------••-- -------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ----------------------------------------------------------------------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 laws, and rule --and regulations of the San Joaquin Local Health District. (Signed)-- ----- ---- ---k-- -- ---'51:� -- By:------------------------- - - ---- ------ ----- -- ---------------- ----------------------------- - -----------------------------:--------(Owner,and/or Contractor) ----------------------------- -----------------------------------------------------------------------------(Title)--------------------------- ------- ----------------- (Plot plan, showing size of lot, location of system in relaflon to wells, buildings, etc., can be placed on reverse side). --FOR DEPAR31MENT US E-ONII APPLICATION ACCEPTED BY---- --W...:Iv --------------------- BUILDINGPERMIT ISSUED REVIEWED BY-------------------------------- ---------------- ---------- DATE---- ------------------------------------------------------- ---------------------------- --------- DATE_ Alterations and/or recommendations:-------------- - --------------------------- --------------------- --------------------------------- ---------------------------------------------------------- ----------------------------------------------------------------------------------------- ------------------- ---------------------------i---------- 7---------------------------------------- ---------------------- - --------------------- ------------- -------------- -----------------------------------------------------------------------------------------____ ----------------------------------- ................... ---------------------------------------------------- -- ----------------------- ------------------- -------------------------- -- ----------- ------------------ -- --------- ---------------------- ------------------ ------------- ------- .................. ------------------------- - -------------------------- -------------------------------I------------- FINAL INSPECTION ------W_ BY:----- - Date..... ------ -- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lod;, California Manteca, California Tracy. California II �, , ES=g 2M I.S446 ATWO.. 12 4-�