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�1 1 xx APPLICATION ,FOR SANITATION PERMIT Permit No. --.,...-.-...-..-...... (Complete in Duplicate) Date Issued _-- 6._.. _ Applica+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 Or •nance No. 549. JOB,ADDRESS AND LOCATION --- -------- '--------------------- -• f.. •---- - -------- ---------------------------------------------- Owner's - - -" ---------------- Owner's Name �- ------------ --- •------ = ^ -. Phone `• a '-R_ ._. Address ------------------------- -------- - -- --- ------- Contractor's Name-- .��Zrt3n - - ------ ---- --- y--------- Phone.-- -2-7Installation will serve: ResidenceHouse ❑ Commercial Trailer Court Motel Other Ej Number of living units: _- _-- Number of bedrooms : Number of baths -----/_ Lot size _--_----��C--.�__-)- x Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes o ❑ New Construction: Yes E}-No ❑ 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--7-Cl -Dista ce from foundation--/e-f_-------Materiak(e C.._._ � --,---'_-_- No. of compartments-------9--�- ---- ------Siz -- � 9 P. -- -------------Capacity---I--�---- .� "- -- -_Li uid dep' - _ - i Disposal Field: Distance from nearest well.7�-----_Distance from foundation— -g°---.---...Distance to nearest lot line---- ------ [� Number of lines------------�-r-......---------Length of'each line--��r'��G��.-.Width of french--------A-_s4!-�------------ '` �r Type of filter material___5-�W . _,__Depth of filter material-__ __ _'�_._---Total length_--_----=T-�-- ---___-----=------- Seepaage Pit: Distance to nearest w -90 -------- om foundation-- °_ -- istence to nearest lot line- � -.. -- 7� Number of its-----°-� -------------�' ize: Diameter----•---•- -�--- ' '� P� -- --- -Lining material---- �S �- -----.-Deptn----�-a---�-�------------ Cesspool: Distance from nearest well----------- rom foundation--------------------Lining material------------------------------------- n Size: Diameter- - -------- -----"--------------Depth----------------_:-----•------------------------------Liquid Capacity ------------------------gals. Privy: Distance from nearest well--------------------------- ------ ------------Distance from nearest building---------- __-__ ❑ Distance to nearest lot' ine---- ------------------------•-•--- -•----------------e-----------•--------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------- ----------------------------•-•-------•-------------- ------------------••-•-----------------------•--------------•----------_----------------------••---------------------------•-------•--•----•------------------•----- .0 , -------------------•-•-----•------•-------------------•--••------•------••---------------------------------------------------•------•------------------------- h' -------------------------------- --- ----- ----- ----------- - --------------- ------•------•----•-------•-•-•--••----------••-------------------- ------------------------------------------- 1 '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 regulations of the San Joaquin Local Ith District. r S� ned _ ��- (Signed)..- i9 )-- Owner and/or Con+rac+orj By _ = ------------ e-rz- ----•---•-------•-- (Title)----- - ---- -------- (Plot plan, showing size of lot,.location o ysfem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..,.-- Y.- '- ---- -- ---- --•- - -------- ------- ------ ------------ -------------- DATE---------------------------- :rr REVIEWED BY DATE - ------------•---------------------------- BUILDING PERMIT ISSUED---------- --- --- --------------------------------•- --------------------------------------- DATE-------------- ------------------------------------- Al+erasi}+oAAii ns and/or r-eWco�mm°endations:- h-. . � +fry :,1, •., .ct►_.' . J�A, . -`"" h ± ----- P'y . ------------ ----------------- � �_L-•,-t.- � --------------- --------- ---------- !r I., V � --. - -------- - == -- ---- ---- ----- ---------------------- FINAL INSP TION Y-------- ---- --- =--- -- Date----------, 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 ES-9-2M 145445 ATWDDD 12-54