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APPLICATION FOR SANITATION PERMIT Permit No. 7 (Complete in Duplicate) Date Issued - /1 4 S - 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 LOCATION------U__-4'�--------- �� ----- 3-�------„S�7^2 --- ------------------------- Owner's Name------------------------------------------------ �'(l ! thGCV Phone Address---------------------_-------------------------�j---� ' r� �� --`----T----------------.----------------------- Contractor's Name-------------------------------•----••------ fy' . ------------------- -•--- --------------------•-------------------•- - Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _Z Number of baths _I---- Lot size -------------60 A' /-_o Water Supply: Public system F71 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe. , Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes K No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ) I--- ----Material---- -------------- S tic Tank: Distance from nearest well---`-+'~__Distance from foundation--) - No. of compartments--_---_-._`�---------Size---- _ x_ -----Liquid depth--------�__0__--__---Capacity... _---_�Od.D r � Dis s Field: Distance from nearest well-----”- ------Distance from foundation--_-�o---------.Distance to nearest lot line---- Number of lines----_____. _____-- _-- Length of each line-_- `o---.Width of french------------ �___------ Type of filter material-__- ----Length of filter material------11?_ -_---Total length----___-----_-_---�_-Zd_.__-------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---- ----------- 0 Number of pits----------------------Lining material------------------ Size: Diameter-----------------------Depth--------------------------------- W Cesspool: Distance from nearest well-----------------Distance from foundation.------------------ Lining material------------------------------------- F-1 Size: Diameter--------------------------------------Depth--------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Disfance from nearest well---------------------------------------- -,----Distance from nearest building Y- ------------_-_-------- ------_--. ❑ Distance to nearest lot line--------- ----------------- --------------------------------------------------------------------------------------------- ------ Remodelingand/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 lawsend r es and regulations of +he San Joaquin Local Health District. MA (Signed]-- -------------------- --- --- -----�r� � (Owner and/or Contractor) By:---------------------------------= -------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (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------- ( >�; Jl"��---------- REVIEWEDBY--------------------------------------------- •-------------- - ----------------------------------------•-------•------------ DATE-------- ----�E BUILDING PERMIT ISSUED---------------------------- ---------- ---------------------- ---- DATE- ; ------ -------------------------- - - - ------------------ ---- ----- - Al+erations and/or reco me dations: __- - ------------- r - R.�2•-`_C3_Y:'------ �A.! ------/CSG - _ ---�^c-.0 -_- '=K?�•1.3.-__ • -- --- -- - ---��- --+--- ---- -?tie - ----- - - --- ------ ---- ----- - - •---- -. -....-- --. s- �` -•---• ------------------------------- ------------------ ------ ---------- --------------------- - ----- ---- -------- ----------- ------------------------------ FINAL INSPECTION BY:.---- -- ------ -------------------------------- Date------------ __---- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT /r 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 10-52 Revised W-2100