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i1 APPLICATION FOR SANITATION PERMIT Permit No. x_72 Fj {Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to constructand install t e w pgiw described. This application is made in compliance w•.h,Coun.ty_Ordinance_No. 549. .E 1iar��; S..- JOB ADDRESS A CATION—. �'�`lN-- Owners Name-. = -------------- --------- Address -------Address ...... ..- - i�Q F� IR67 t - I Confractor's Name- - ----- , t' '' .�--------------- -- ------ Phon .�a�".._4-- L_-b- Installation will serve: Residence e--Apartment House [❑ Commercial ❑ Trailer Court ❑ Mote�ll El Other ❑ Number of living units: ___ ___ Number of bedrooms _ - Number of baths ---f.__ Lot size --- -,?�_.I Water Supply: Public system ❑ Community system E] Private �epth to Water Table _{- ft. Character of soil to a depth of 3 feet: Sand PGravel [I Sandy Loam E], Clay Loam ❑ Clay E] Adobe Hardpan El Previous Application Made: Yes F] No VNew Construction: Yes 9?"No ❑ TYPE OF INSTALLATION e AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___�41-----Distan from founclation_.-_)d -.Mate ial-------------------- No. ___-----�__ ___ --_-_-__-- �iv�/ , e, q No, of com artments______. -. --____ Size_ �f _-- 3�_ _Li uid de +h____,�" _____________Ca aci Aa P rJ� ,- q p Capacity -� Disposal ield: Distance from nearest well.. ...Distance from foundation_-_1Q__.__-._Distance to nearest lot lire___-� Number of lines----------L.-r- -.r _ _-. -Length of each line_ Q � ---- -- rr Width of french----p_2y---_------------------- Type of filter material_1Iv'I--------------___Depth of filter material_-.,- _- -----------Total ` - QDiameter _ le--ngth___--- O!--_---_-----_ _-_-__________.-___. Seepa ePit: Distance to nearest well- _ < �0-_- ____Distance fro fou dation-__-X 7___.Distance to nearest lot line -_`S_-_.__ , Dumber of pits. �____._______Lining materia4 Size: Diameter___-_� r.-- Depth------ 3-f-------............... Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__.---________,_-----_--_____-__----. ❑; Size: Diameter-------------------------------------De th---------------------------------•--------- Liquid Capacity gals. Privy: , Distance from nearest well.-_---------------------------------------------Distance from nearest building----------------------------------------__ ❑ Distance'to nearest lot line-------- ------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):------------------------------------------ --•----------------------------------•--------------------------------------------------------------•--•-•---- E---••------------------------------------------- -------- ----------•---------------------------- -•------------------•---------------•---- ---------------------------------------------------------------- --------------•--------------------------------------••------• •--------•-------------------------------------------------- ---------------------------- ----------•---•------_-------------------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe laws, 9d rules and regulations of the San Joaquin Local Health District. -----• ------- ---------------------------------------------- ------ and/or Contractor) (Signed)---------------------- BY= ------------------------------------------------------(Title) �"i4C --------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -------------------- - ----------- DATE_ .- REVIEWED BY -------7--24- ------- ------------------------------------- ---------------------------- ------------- DATE--------------------..-.------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:--.--------------- ------------- ----------------••-------------------=------------------------••----•-•--------------- = € i -----•------------------------------ ---------•------------•----------------- ------------------------------ -- ------------------- --------------------------...------------------------------------------------------ -------------------•------------------------------------------------=-•-- ------ ---------------------------------------------------------_:----------------------------------------------------------------------------- -- # FINAL INSPECTION BY-----------------f -------------------------------- ------- 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 - Revised W2100