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�S "� I l APPLICATION FOR SANITATION PERMIT Permit No. ._-3_. " (Complete in Duplicate) +� Date Issued _[- ,-3-:_-__- 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. —"` 5, , 7)dY JOB ADDRESS AND LOC ION '7� ----------------------------------------- --------------------------•-•-------- � ----------- Owner's Name--------- ..- -- ------ - ----- --------------- --• Met- Phone f ` Address.----- --------------- ------------ Contractor's Name------------- ---------- ------ _��." � ------------------------------------- Phone----- z� Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other tt�❑ Number of living units) -__�__ Number of bedrooms _-9__ Number of baths _,__,�_ Lot size ----_ _ �-__ -___ --c _l -------------- II ' Water Supply: Public system Community system '❑ Private ❑ Depth to Water Table .___---- ft. Character of soil to a depth 11 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes E] No New Construction: Yes Flo ❑ TYPE OF INSTALLATION !1ND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! J-1fI. V4 Septic nk2l Distance]1from nearest well_-Disfance,from fpundafion..--,/-d-___-.Mat riy� _,_-- No. of compartments-------- -------------Size--- -1 _ --Liquid depth------ ----------Capacity..._._ _ _ ! Dispos ieId: Distance�from nearest well._ Distance from foundation-__;� Distance to nearest lot line, ---. ----- el ---------- Number of lines------- _-- Length of each line-----0-------_�--------Width of french_-__-----*A/---------------- Type of filter material _Depth of filter material----Z -----------Total length-------- _L -------------------- Seepage Pit: Distancei`to nearest weil___________ __ Distance from foundation_-_-_-_--_-_.__---.Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material__ --------------------Size: Diameter------------------------Depth--------------------------------- i Cesspool: Distancsl�from nearest well-----------------Distance from foundation--------------------Lining material____-_---_-________----____---____-. ❑ Size: Diameter--------------------------------------Depth---------------------------------------- ----Liquid Capacity-------------_----------- tea .-Distance from nearest buildin Privy: Distance from nearest well---------------------------- ---------------- g---------------------------=-------...... . ❑ Distance)to nearest lot line------------------------------------ -------- --r---------------------- -----------------------------------------...._------------------ Remodeling and/or repairing (describe):----------kis -• = !Il -------------------------------------------------lG -- ----------------------------------- --------A——---------------------------------------------------...--------------------------------------------------------------------------------------------1 ------------- hereby certify that I d&ve prepared this application. and that the work will be done in accordance with San Joaquin County, I + ordinances, State laws, and lfules and egulations of the San Joaquin Local Health District. Y- b I (Signed) =-----=---- ----- „ - -------- -----------------( wner an /o ontractor) r ..e1:�4 r�� By:-------------- 6 - - -------------------------------------------------------------------(Title)---- -- ---------- Iil M (Piot plan, showing size of lob, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED! Y-------------------- --------------------------------- ----- DATEE---------- r ---- REVIEWEDBY----------------------1II1---------------------- --------------------------------- HATE------------------------------------------------------------ BUILDING PERMIT 155UED111 ----------------------------------- ---------------------------- DATE Alterations acrd/or recommeilda+ions------ - -------------------- -- ---------- ---------------------- ------------------------------- ------------------------------------------------------- ----------------------------------------------- ----------------- ------------------------------------------------------------------------------- ----------------- -- ----------------------- -----------------------1111-------------------------- ------------•------------------------------------------------------------------------------------------------ -------------------------------------- -----------------------------------------------I------------------------------- -- - --------------------------------- ---------------------------- --------------------------=----------------------------------- - - --- ----- - --------- ------------------------------- -------------- --------------- ----------------------------------------� FINAL INSPECTION BY:��._.------ - i ) ) i SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I j Lodi, California Manteca, California Tracy, California ' I ES-9-2M 8-51 Revised W-2100 i JG _ _ _ _