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`7 APPLICATION FOR SANITATION PERMIT Permit No. ---------------- (Complete - - -'-----/_(Complete in Duplicate) Date Issued _ � -b- 3- I pplication 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 Ordin nce No. 549. JOB ADDRESS A D LOCATION.___,-Z_D_-; ----- ---------------•---------- ---------•-- Owner's Name - -• -= (�`may- --- ------------- 7 .. ,.,. -------------- ------------------------------------ Phone--- /- Address---------------•----�7 _�_ �_� Contractor's Name__________ ________ __ � Q - ---------------•-- Phone-- ------/•----0-•------ -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ _ Number of bedrooms - - Number of baths __I__ Lot size ---1-GO - ---------------- Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table --ya ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 3--'Hardpan ❑ Previous Application Made: Yes E] Noew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tnk: Distance from nearest well__-__'J_-Distan 'from foun at•on__ 11 11, r' ei ------------------------------------------- No. -----V----- ----�_1____ --- f1_-____---.Mat rias No. of com artments_ --- - p ------------'01- ..__5iz��-�`-�(i- -,X• -*�-Liquid depth----��---0�--- -------Capacity_Capacity-.f - Dispos I- Field: Distance from nearest well. _____- _.Distance from foundation---_/- �� ___-___---Distance to nearest lot line________ __Q Number of lines__________ 1- --__-_ Length of each lin x,710_-•- g � ��--- ---- -Width of trench._ Type of filter materiall -- --__Depth of filter material- - _ y - - --------Total length___-,f d---••-------------------------- r 41r r ---------Seeps it: Distance to nearest well-.----------------Distance fro fou ation__--_/d------_Distance to nearest lot li V Number of pits--____--.�__--____-- Lining material-�Ca ?- Size: Diameter----•---- --- --- Depth---.4-----•--------------- esspool: Distance from nearest well________________ Distance from foundation------___----_ - -----.Lining material--------------------------------------- 0 Size: Diameter--------------------------------------Depth---------------------------•-------.----------------Liduid Capacity------------------ --------gals. Privy: Distance from nearest well--------_---------------_--_---------- - -Distance from nearest building ❑ Distance to nearest lot line--------------------------------=-------__--- ' -------------------- Remodeling and/or repairing (describe)_________________________________ •----------------------------------------------•---••--------------------------------------•--------------------------------------------------------- ------------------------------------------------ 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 focal Health District. (Signed)------- . -------------- --------------------•------------------------------------------------------ er and/or Contractor) By:. ----------- {Title) ----- ----- ---- _-------------- ------ (Plot - --- -- ------------------- - --------- -- ---------------- -- ot p an, 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----------- - REVIEWEDBY_ -------------- -------------------------------------- ------ DATE--- - ------------------------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------ DATE_- ----= Alterations and/or recommend stions: _________________________ ----------------------------------------------------------------------------------- - -- ----- ------------ ----------------------- FINAL INSPECTION BY----------------------------------- j-,_ 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 I E5-4-2M 10-52 Revised W-2)00 1