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. 1 - _ _7 1 APPLICATION FOR SANITATION PERMIT a Permit N -S �� (Complete in Duplicate) Date Issued A Applica}iori 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 A LOCAT N._ -_ .--1/ / ••__,____ � 1,—y✓ s Owner's Name :.... ......................... ------------------ --------------- ---- --------------- Phone.. = Address- = Contractor's Name.-. �✓ ` i,.i r,a<,,,_..--�.,� vim". 1 f _ - - • ------- -- Phon • -- ................... Installation will serve: Residence Apartment House ❑ Commercial ] Trailer Court ❑ Motel ElOther E] Number of living units: _.]_ Number of bedrooms N—_— Number of baths _..l-:_ Lot'size __.. Water Supply: Publicjsystem ❑ 'Community system .b Private �pth to Water Table'-!VV ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 6--lq_ew Construction: YesC,.� TYPE OF INSTALLATION. AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septi Tank: Distance from nearest well--.//.a .Distance from foundation_.-_- ~e f --------- -- ---------- ®��""` No. of compartments...._.....�•. ......_Size__ -----�C. D Liquid dap%h...-. L Capauty ��---. Dispo al Field: Distance from nearest well-.-�d.-'•-.'Distance from foundation.---_-1 -_-....Distance to nearest lot line._.____,•. Number o{ lines___..'.. ....f- -- Length of each line------ -40/0 -----Width of french_----Z–`f___________ _____:_ t Type of filter material._...l4 ...f / Depth of filter material----- -_ Total lengfih.--... G'-__-_ Seep ge Pit: Distance-to. nearest.well..--1A ---._--bistance"f am founndation....._7!5.-_.Distance to nearest lot line---- Number of pits-_ :._.. _ . _.-'Lining'matsrial_-, {-..Size: Diameter. .____-_-..De tn_-. ^� �. p ' r` Cesspool: Distance from nearest well-----------------Distance from foundation._.......---------Lining material..................................... ❑ Size: Diameter---=----`----------- ------- ----De th------ i.--.-••-........----- ----------- -----_'Li uid Capacity � - p. r q •----•-•................. ..gals. O Privy: Distance from nearest.well--------------------------------r Distance from nearest building------------ ------------------------- ❑ Distance-to nearest lot fine-_ ......--`---- - . _ :., -----•----•-------------••------•- Q Remodeling and/or;repairing (describe):-_---------.-_.- - , --------------••-•--------------•-----•--•----••----•----------••-------------------------------•------- •--•-----•...............•-•-•-....._..........---•---- _.: --------•-----------------••----...----•-----------•--•------------------------- ----------------------------------------- ................................................. ;--------------- --------------------------------- ....... ...............................I......................------------------------------------------------------------------------------------------------------- ------.......... —N 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin-County ordinances, S laws, nd rule d ragul tions of the S n Joaquin Local Health D' rict. w ` (Signed)------ -- ,.--- .erContractor) By:... ,�- -P - -----------------------•---------------...... -- (Title) - ---- - -� (Plot plan, showing size of lot, location'of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--------- ........L�' � ....... DATE -------------------•-------...- REVIEWED BY -- ---------------- ------ ... DATE-------------- ` . BUILDING PERMIT ISSUED = = - DATE ` � �- Alterations and/or recommendations: .-.�--------------------------------------------------•--•--.----- ---------•--------•------. -----------•- 1 ......................................................................... .•.-.-- ------------- .................................................... .------------- --------------C-1 ............ tis ............... -------------LC-1---.---....-.•...........•••---------.....-.-------------- ------------------- ------------------------- FINAL INSPECTION -BY: - Da+e....- -- ..3. "� 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 E5-9-2M ; Revised W-2100