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APPLICATION FOR SANITATION PERMIT Permit No. .._-_1.. _ .. 3 (Complete in Duplicate) Date Issued --------------•_--••� This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w�5A er "n crbed.- This application is made in compliance with County Ordinance No. 549. O<�'6 e(4,0 Of JOB ADDRESS ANW31�L CATION- :- -- -------�- -- - 4f -- Ph one------------------------------------ Owner's Name. ----�------ - - - - - -------------------- --------- ----- -----------------.--------- Address_.. --------------------- --------------- ---- - ---- ! -------- /� Contractor's Name --- ---------------- Installation will serve: Residence Apartment Houser❑ Commercial ❑ Trailer Court l p otel ❑ Other ❑ Number of living units: I------ Number of bedrooms _-a_ Number of baths ---- Lot 'size .l CI ----3-y-* -----------•---------- Water Supply: Public system ❑ Community system ❑ Private le Depth to Water Table R6-ft, 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ I Previous Application Made: Yes ElNo NJ New Construction, Yes X No ElfHA/VA: Yes ❑ No [I ` 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___ pd- ---Dis#an� from foundation---la Ma eriaL______________ _ No. of com artmenfis vZ-----------------Size_`f__k- _ - -----Liquid depth----- -°-'--.--------------Capacity_ _ -----• P _ _ .- la±________.Distance to nearest lot hne_�__.--.__-_ Disposal Field: Distance from nearest weii_ .7._q--_.__.Distance from foundafiion_ _ Width of trench.__ --- -------------------- Number of lines_____1;-=_____---_-`-fit�_�--jt Length of each line___--�-e2�-------------- Type of filter material �_ f $_--Depth of filter materia!-___ _�_��-_____.Total length____/"' ---- - --• d-____.Dista2ce to nearest lot ne__C-__-__---- Seepage Pit: Distance to nearest well__-/ _�-'--#-Distanc from fou dation____ p_.- Number of pits___2--- g a e� .$ize: Diameter--- -----------Depth_._a�!- ------------------------ Cess ool: Distance from nearest well-------_________Distance,from foundation__.__.___._.,__._-.Lining material______-_.____-_____._____-______.____. - - Linin mater t, --------------------------Liquid Capacity----------------------------gals. ❑ Size: Diameter----- --------------------------= --Depth --------- ----------- �*- - -______-_Distance from nearest building Privy: Distance from nearest well----------- --------- i ❑ Distance to nearest lot line-------------'------------ --------------- ----------- ---- 3 d! ------------------------------ Remodeling and/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 s, and rules and re Mations of the San Joaquin Local Health District. ----------------------- - r r Contractor) Si red I I '° --------- (Owner and/o Co r) ( 9 ) - - - c. r. ------------ (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___!_ '-(- ------------------------------ REVIEWED BY----------------- - ----------- ------- ----- ---------- ----------- ------ - -- ----------- -------------------------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------- ------ Alterations and/or recommendations:--------- _________________________ _ ------------------------------------------------------------------------- --- --------- -------------------- ---------------------- --- ----------------------------- ------ ---- �� Date - - -- - FINAL INSPECTION BY: - -- - ------- 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-9-2M Revised 8-'59 F.F.CD.