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} �} APPLICATION FOR SANITATION PERMIT Permit No. -� --� (Complete in Duplicate} �v 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 N . 549. JOB ADDRESS AND LOCATION---- ------f�3 _.r ._. -- ----- ` LQ d -'�"- -• . ,.r Phone--------- Owner's Name-------------- =------------------------ a -------------------------------------- ------------------------------------------------ Address------------------------------------------------------ an Phone-------7�-e¢ Contractor's Name------------------------------------------------- '� cs1N)---- Installation will serve: Residence )( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�-- Number of bedrooms ll Number of baths __I-___ Lot size __ ° ,�r -r- - -f Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 44eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)g Hardpan ❑ Previous Application Made: Yes ❑ No 14 New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet..) /� n I _Material--L�--L-` '�"'--- '�K Septic Tank: Distance from nearest well --Distance from foundation__ ___________ _ . - �s _Capacity-- AjdNo. of compartments--- -l�dd.-_-------Size_. . ---- --- Liquid deptF�. ------------- , Disposal Field: 1-- Distance from nearest well__-42(`�c-_Distance from foundation_tQ-_ -------Distance to nearest lot line--------- -- --- Len th of each line_:_-p- -- - Width of trench-.'L- ------------------------ Number of lines_________I----- �- --- 9 pp i i Type or filter matenal___1 V1 -�4- -Depth of filter material__-._I- Ca _.__ -Total length-------------------- Q---- r _- Distance to nearest lot line____ Distant from foundationQ_..__.. Seepage Pit: Distance to nearest well__ GljA_Es ---- Size: Diameter__ ��- Depth_�S� I- ------ ------Lining material _. S J-, - l Number of pits---- - 1 J Cesspool: Distance from nearest well-----------------Distance Froin foundation--------------------Lining material__.________------ gals. Size: Diameter Depth-----------------------------------------------------Liquid Capacity- ------------- T ----------- -- ❑ . a Distancejrom nearest building____-_________--_____-___-_ -__.__. Privy: --`------------------------------ `— Distance from nearest yell_________. ❑ Distance to nearest lot line-------------------------------------------------------- ------- ----•---r---�'----------- � �- ---- - .�_ _ __/ Pef' Remodeljng a d/ar rep iris [describe)______ ________ . `- ► Ir i ------------------------------------------------------------•------------------- ¢ _ __ ____________________i.____________-__________.______---_---__------__------____---__----_____. --------------------------------- -__-.________.____________________________--_______.__-_____.___._ I hereby certify that I have prepared #his application and that the work will be done in accordance with San Joaquin County ordinances, p and rules and ulations of the San Joaquin Local Health District, pvOR .Contractor) Sined ---•---------•------ --- ------- -------[Ti+le} ^ oma.,-------------------------- ' (Plot plan, showing size of lot,.location of sys+em i elation to wells wldings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---------------------------------- ------------ ------ DATE-_5=3b -------------------------------------------------- DATE- -------------------------•----------------------- REVIEWED BY------------------=------------- ------ Bl71LDING PERMIT ISSUED------------- ---------- ----------------- DATE.---�-�- �------------------------------------------------ BUILDING ------------------ ---- -------------...------- Alterations and/or recommendations:-------------- ---------------------------- . ----------------------------------------- ------ Date__- -----------------------------------� --- �[ 7------/ ------------ -------- FINAL INSPECTION BY ---- --- ------ -- ------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street l30 South American Street Trecy, California Stockton, California Lodi, California Manteca, California E5-9-2M is-52 Revised W-2100