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APPLICATION FOR SANITATION PERMIT Permit No. d� ---------------- (Complete ------'-------- (Complete in Duplicate) Date Issued5-3 _`-__'"- Application is hereby m e to the San Joaquin Local Health District for a permit to construct and instal e- ork herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 1_0C4TION--- ----- s c� Owner's Name--------- � I Pe Address ------- Contractor's Name - _ -------------------------------------------------- ----------------------------------- Phone--------------------------- ---- Installation will serve: Residence ❑ Apartment House ❑ Commercial. ❑ Trailer Court ❑ Motel ❑ Other I Number of living units: _-V--- Number of bedrooms ---6--- Number,of baths _- -_ Lot size ---_ Water Supply: Public system ❑ Community system -❑ Private K Depth to Water Table.3 t. Character of soil to a depth of 3 feet: Sane} Gravel Sand Loam Clay Loam Clay P ❑ ❑ Y ❑ y ❑ y ❑ .Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �" New Construction: YesA No F-1T1�PE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well_ -----Distance frooupdtion_____ ___.Materiai-___ No. of com artments__-- ` p Size . == ` ' Liquid"depth ----------Capacity-- �,•' Disposal Field: Distance from nearest well_ ---.Distance from foundation---- - O______Distance to nearest lot line___ Number of lines--------------/-------------.._ _Length of each line_-__= ` _ _._ Width of trench___--_, '___----______ Type of filter material,----- -Depth of filter material___-_- ___ ---f _Total length----------- --_____________________ Seepage Pit: Distance to nearest well----- _____Distance from foundation-__ - ZZ------Distance to nearest lot lin�e____r' Number of pits---------_�___-_____Lining material-7��--__-Size: 'fir-_t�C_�(__ �j___.Depth �� _ Cess- ol: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------- . ❑ Size: Diameter-------------------------------------Depth--------------------- ------------------------- Liquid Capacity__-______-_----------------gals. . ;. . Privy: '"" Distance from nearest well____ __________________________________________Distance from nearest uildin g --------------- ❑ Distance to nearest lot line---------------------------------- -- ----------------------- olzp Remodeling and/ororepairing (describe):_--.s• F?- '- ___ �__` __t'� _ nw • 'l -• '� J - p- ......A--- n-- _ _ d I hereby certify that I have prepared this application and that thZork will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulations of the San Joaquin'Local Health District. (Signed)_. _ ... . �.--�.�_. " ------ ----------------------------------------------(Owner and/or Contractor) ey:... ---------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of.lot, location of system-in-relation to wells, buildings; etc., can be placed on-reverse side): - -_-o- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ --------- ------ ---------------------------- ------------ DATE. ........... REVIEWED BY ` ry -- DATE- '`r BUILDING PERMIT ISSUED----------------- ---------- � _ ------------------------- - - _ - ------ ------- ------ TE �sR- AI}erati ns aY nd/or r commendations:__ : _ _ _4_t-Q {---- e�f}:- -� A r-An ��4 t -------------- y - A --- ----------- •-------- � --- --z=. - c ---- - -- --- --- - r ----- FINAL INSPECTIO BY------ ----------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 8-51 Revised W-2100