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APPLICATION FOR SANITATION PERMIT Permit No.0_4�1(9___v (Complete in Duplicate) Date Issued f 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 LOCAT ---------- JI N___ ; R /L ----/-1- -.1-- ------ -- ------- --------- ---------- --------- ----------- Owner's Name--------- _,C7-_tA 4--011 hone- ............ ------------- -------------- . ---------- ---------- ---------------------- r --------------- --------------------------- -- ----- ------------- Address----------------------- Contractor's Name--.- ---- Phone-- Installation will serve: Residence [b,/Apartment House E] Commercial 0 Trailer Court E] Motel E] /Other El Number of living units: er of bedrooms t- Number of baths J---- Lot size ---__-7(r -------------- Water Supply: Public system ;;;;=unify system C] Private Ej Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand 9__-�ravel E] Sandy Loam 'y Loam E] Clay E] Adobe �Hardpan El Previous Application Made: Yes E] No New Construction: Yes No F-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank-1. "04-- Distance from nearest well-----------------Distance from foundation--------- � - -----------Material------------------------------------------------- N 011`1.44 No of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacify----------------------- Disposal Field? Distance from nearest well-_____________Distance from foundation--------------------Distance to nearest lot line____________.___. Q Number ine------------ Number of lines__________________________________Length of each line------------------------------Width of trench______----------___________________ V Type of filter material___-_- epth of filter material-----------------------Total length-------------------- --- --------------- --- Seepage Distance to neareswell_/Vt---------------Distance f om fo 11claflon-1-��__Distance to nearest lot line__��____ Number of its--- Lining material- ---------- -`---Size: Diameter----?---------------Depth----- Cesspooi: Distance from nearest well----------------Distance from foundation--------------------Lining material-____________________________________ Size: Diameter------------------------------ -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. -Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------- ---------- El Distance to nearest lot line--------------- ----------------------------------- ----------- -------------------------- Remodeling and/or repairing (describe): ��x-- ---- ----- ------ -- ---------------------- ......... ------------------------------------------------ ----6. ?------ _-Z------------ -------- - --------------------------------------------------- --------------------------------------- ---------- -------------------------- ------------------------------------------------ -- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------/------I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe_jaws and rules and regulations of the San Joaquin ( fde Local/ealth District. ' SigndAd (Owner n ! or n1rac .t.o..r.)e --- - ------ ------ By:. - / -----By- C: _/ - (Tifie)------ ...... (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---------------------------------------- -- ----- ---------- q 5t . ------------------------------ DATE------------- ----------------------------------------- ------------------------------ DATE---- --- - ---------- -------- REVIEWED BY---------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:---------- --------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- --- ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- 1148.,�Clle - FINAL INSPECTION BY:----------------v----------------------- ------- 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 ES-9-2M 8-51 Revised W-2100