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�r APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 f � Date 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 LOCA710N________- _ J---------------------------------- - /_y__ - -------•------------- Owner's Name------- ........ ----•-----•/W& _ ------------------------- ------------- -------- Phone ------------------- - Address----------------- -------3 X7.W_A.:1-----•--•----------------------•---•----- Contractor's Name . r_x_z------ ------7" ------------------------------------- ��'�/��/s __ Phone-Z-4, Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [:] Motel [I Other D Number of living units: --I____ Number of bedrooms __/__ Number of baths __1-__ Lot size ------------------- Water Supply: Public systemCommunity system E] Private ElDepth to Water Table __ 0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑�Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se✓✓tic Tank, Distance from nearest well---A14_�V'SDistance fr--9-p"- foun-d9fion___/40____F__ ----------- - . ---_F.y---C--I -No. of compartments------Z----- --.--- --.Liquid depth----,I-;re -------------Capacity Disposal Field: Distance from nearest eli._-_10 %istance from foundation___ -V�_______.Distance to nearest lot line___ ,,[------- Number of lines------------- Length of each line------- _---_ Width of french------ f�_'�__---_- --- --- ----- --- or Type of filter material_ __ -� ___Depth of filter material____-�--- - -Total length________ �1______________ ,�/ ��j ------ See a ePit: Distance to nearest well__ av -------Distance f r, Distancefoundatlon____.1Z.7.___. to nearest to Number of pits------I_-____-___--Lining material-------�Q.��-Size: Diameter----��----------Depth------ --_- Cesspool: Distance from nearest well-----------------Distance from foundation.-_-_____,____.___.Lining material__._____- _-______.____ 1 --------- Size: Diameter_----- Depth----------------------------------------------------Liquid Capacity-----------------------------5als. ; Privy: Distance from nearest well------ -_-----------------------------------------Distance from nearest buildin 9 ❑ Distance to nearest lot line---------------- ----------------- ----------------------------- Remodeling and/or repairing (describe):----------------- 4 " --•-------------------•----------------------------------------------------------------------:-----------------------------------------------•---•------•---------------- ----------- ----------------1------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- -------------------------•-••-------•----------------------------------------->------•----------------•---------•-----------------------------------•-----•-----------------•-----------------••-•------•-------- ------------------ ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------•------------•------------------- I hereby certify that I have pr red this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, andn__r cf re ations a San-Joaquin Local Health District. {Signed} ----- --- 47= (Owner and/or Contractor) By------------------------------------•---------------------- (Title) (Plot plan, showing size of lot, location of system ' relation to wells, buil s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- -- --------------------------------------------------- DATE------ -- -- -- REVIEWED BY--------------------------- ---------------- = - -------• -- _ DATE F J BUILDING PERMIT ISSUED--------------------- ---- --- -------------- DATE---------------------------------------------•-------------- Alterations and/or recommendations:_____F___._______--�.__.._____._,_s- �.- --------------I------------------------------ ----•---------------- t .� - - ---- • ---•- - -- •----------•• - ------ --------------- - --- ------------ -- - ---- ---------- -------------------- ------------•-- ------- --•--- ------------------- ----------•------------------------------------ // — joy FINAL INSPECTION BY:. ------------- ------------ Date---� SAN JOAQUIN LOCA HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 EPM-