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4 N S APPLICATION FOR SANITATION PERMIT Permit No.� _3__-..___ '� (Complete in Duplicate) Date Issued ___- :_ App is tian is ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This plication is made in compliance with County Ordinance No. 549. JOB ADDRESS A D,.LOCATION______--1--� --------- 2 .. . . __oOwner's Name----- C o M_ r Address----------P1--•- .......ATk.EE_._... Contractor's Name + ---------------•------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence V Apartment House ❑ Commercial ❑ Tra1fir Court E] Motel ❑ Other ❑ .� Number of living units: ____.___ Number of bedrooms _�__ Number of baths _�-a Lot size ______UU___y�p_X-_-1-_7_______________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hard Pn ❑ Previous Application MiZIe�Yes-❑YNO ❑ New Construction: Yes%0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) l Septic 'ank: Distance from nearest well___________---__Distance rfrom/ oun P#-ion_ _�-_0__.__-_- Materjal____R -------------------------------- No. _H.1 odn _...______.Q �. JV No. of compartments---._.---------------Size___ _.x_- ---X_s--_.Liquid depth ---.---14 =----------Capacity- •4- ------- Dispos Field: Distance from nearest well----r-------Distance from foundation.-L-o----------- Distance to'nearest;iot,line__-�.1_ Number of lines_ ____ ________________ _____Length of each line. r _3a��°l _--Wid#h of french Type of filter material__ _____ __ Depth of filter material----- _f_ --___---_-.Total length-----L�� ---------------------- Seepage _ _ -__________-_-- Seepage Pit: Distance to nearest weL_____---_------------Distance from foundation--------------------Distance to nearest lot iine----------------- El Number of pits----------------------Lining material-------------------_---Size: Diameter----------_t-..........Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material------------------------------------- E _-_-_ __--___-____.__-__.__.___E Size: Diameter-------------------------------------Depth----;.----------------------------------------------Liquid Capacity------------------------------------------------ Privy: Distance from nearest well------_--------------------------- _---------------Distance from nearesf building_____..___.__.__.________-----.______.___. ❑ Distance to nearest lot line Remode€ing and/or repairing Idescribe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ -•- ----------•------•------------•--- ------------•---------------------------------- I hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, Statejaws' � rul anregulations of the San Joaquin Local Health District. ri (Signed) - _ 'rte --.�—----------------------------------------------------(Owner and/or Contractor) By ----•--------------•-•-•--•---------------------------- -- ---------------------------------------------•-----------------------(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------ rpt = DATE REVIEWEDBY ------------------------------------------------------- DATE------------------- -------------• ------------------------ BUILDING PERMIT ISSUED----------------- --- -- -- DAT --------------------- ---- Alterations and r recommendations:---_-______ _____________ -- -- -------- '"V- .- � ------------ ------ --- --------- -- •------------------- ql-]-'13 - -------------------------------(",_4 ---------- --------- ------------ ------- --- --- --- ------------ FINAL INSPECTION BY____ __________ __ - --- ----- 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 10-52 Revised W-2160