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APPLICATION FOR SANITATION 31 s TON PERMIT Permit No. ---- 1 ` (Complete in Duplicate) (p S l Date Issued ----- � +--------- kl 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. 1 JOB ADDRESS AND LOCATION--___Z_,_Q_,_-_6 ! S f'dE --------------------------------------------------------------- Owner's Name--------- --------- ----------------- --------------------------------------- PhoneI Address-----------•-----•---1-a->-e�j Contractor's Name------&.--,... --` f Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms _�_ Number of baths ._.r__ Lot size __---_ p._1 _ __ _____________._.._.__.- Water Supply: Public system ( Community system ❑ Private [❑ Depth to Water Table _6� ft. i Character of soil to a depth of.3 feet:: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe j4 Hardpan ❑ Previous Application Made: ,Yes ❑ No 2 New Construction: Yes 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---------------- Dista•nce from foundation__--_---___--__--_-.Material_----___-_ __-.--1.------.-----_-------------- ' E�ai.i rlv 6 - . _ ❑ No. of compartments }Size = -- - # ---Liquid depth--------------- ---------Capacity---------------------- s Disposal Field: Distance from nearest --_Distance from foundation----_ "-_----_Distance to nearest lot life_____ _________ ® %/ei'Wic Number of lines-------•- ----------------------1L;ength of each line------_c&i?--------_t----.Width of trench------_Z8-____-------------- Type of filter material__--«rY�---.___Depth{of filter material ..`N--e_ev_E----Total length-------9_4�---------------------------- Seepage -------------__-See a e Pit: Distance to nearest well----if!OKF____Distance from foun atlon____!2'_L_________'Distance to nearest lot line__./_0_ ____.. © Number of pits-------1------------Lining material C_:C_dTft'4&S' e:1Diameter__..___3_,3---.._ Depth th--__-- Cesspool: Distance from nearest well-----------------Distance fromJoundation_..--`'17"'_r.....Lining material--------------- ❑ T l a..� ` Size: Diameter Depth ------------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------________--------------.----------Distance from nearest building------_----------------------------------- ❑ Distance to nearest lot line------------------------ ----' 4----- -------------- --------------------------------_--------------------------------------------------------- Remodeling and/or repairing (describe)----------------------------i____r __ : _ - ---------------------------- ------------4 --------------------------------Z------------ rkq ---------------- --------------------------------------- ------------------------------------------ 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 rules and regulations of the San Joaquin Local Health District. (Signed)•------- *' .5 ,' �---Z ---- --- ------------ --A---- ---.____ (Ower and/or Contractor) By:..... ---------------------------------------------------------Title C = - (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ DATE-= REVIEWEDBY-------------------------------- ------�------------------------------------------------------------- --------------• DATE-- - ---------------------'------------------•-------- BUILDING PERMIT ISSUED--------- ---------------------------------------------------- ------------------------ DATE-- Alterations and/or recommendations----------------------------------- -- - -------•---•--•-------------------------------------•----------------------------------------------------•----•----------- -•--------------------•----•--------------- -----•-------------------------•-------•---•----------- -------------------•---------------- -----•--------------•----------- -------------•------------------•-••--------------•--------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:----- - �.t-------------- --------- Date------.1. C 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 v Tracy, California ES-9-2M I0-52 Revised W-2100