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bl vc,, APPLICATION FOR SANITATION PERMIT Permit No. G---_... (Complete in Duplicate) (111 Date issued __ _ __-S_�______ Applica-lion 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. �� A- -------R C ---- JOB ADDRESS AND LOCATION._ A V�i------------•---- /�� p -- ---------•----•--/--•-- Owner's Name-------> - 44-7-4. ----------�L-t / aS� --------- Phone fi/ =• T&r'�!/a� Address---------------------------- �pf Contractor's Name-------- ---1_. i '` R--- ------ .................-----------•--- -------•----•--- Phone_ . r/�l�/�'�� Installation will serve: Residence NL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms Ai�7�Number of baths L------ Lot size ---------------_--_------__ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table _4_4_X'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ No!� ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation--------------------Material, _________________._-- ❑EYISf e1G No. of compartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---------------_Distance from foundation_____________-_--_.Distance' to nearest lot line------------ ❑F_XIS1?KG* Number of lines-- --------------------------------Length of each line------------------------------Width of french-------------------------- ------_-- 1" Type of filter material-------------------------Depth of filter material-----------------------Total length-------.-_---------.------------___------- S of Seepage Pit: Distance to nearest well---/V0tVZ___Distance�(om foundation_.:Za ___Dis lance to nearest l # l• �__z( __--. ./ Number of pits.-Q YS _-----Lining material---- - 4_ri((,a_Size: Diameter -- --------------Depth_ --------------------- 1 Cesspool: Distance from nearest well-________________Distance from foundation__.______---.------.Lining material___._.__________---_---__________-__. ❑ Size: Diameter--------------------------------------Depth------------=----------------- ---------t- Liquid Capacity- -------------------- Privy: apacity gals. �.— Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------- 1-1 Distance to nearest lot line----------------------------- --------------------------------------- Remodeling and/or repairing (describe):----/Q_ddl_V_ ---------- -------------------------------- ----------------1------------------- ---------------------------------------------------------- ------------------------------------------------------------------------------------• v -------------------------------------------------- ----- --------------------------------------------------•-----------------------••---------------------------------------------------....-------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la�rsr-a and regulations of the San Joaquin Local Health District. (Signed)------------- •-------- --- �� -------------- (Owner gn or Con rector} a By:.....................� .. ....... . -----------------(Title)------ = (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plac on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- DATE - �- -- -•--•------------------- REVIEWED BY- � ------------------------------ ------ DATE-_ � i' - -------------- BUILDINGPERMIT ISSUED--------------- ` ------------------------ -------------------•---•------------ DATE------ -----------------------------------------------•------ Alterations and/or recommendations--------------------------------------------------------------------------•--•----------------- --------------------------•----------------------- •--•----------------------------- --------------•-------------------------••--------------------------------.--------------------------• -------------------••---------•--- ----------------------- -------------1-------------------•-------•--•------------------------ -------------•-••------i---------------------------------------------------------------------------------------------------- FINAL INSPECTION BY-------------------------M-------------------------- Date----------'S b--- -- 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 ; Revised W-2100