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a � APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date Issued 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 No. 549. JOB ADDRESS AND LOCATION._.11 ._ -... -Q_X--_./ �____ ________ __ .... y ,* Owners Name ------------------•- ,I X�....�j�...f.. _ _� fid. 4- --- ---- - Phone ._ Address..,S1 M&.=..FMI--fe-- , Contractor's Name............................... -•ARRiS4------rte-C - - ------ Phone--- :rgllue"1' - ---------------------------------------------- Installation will serve: Residence '$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ Number of bedrooms �---- I--. Number of baths •l.-_ Lot size ...��...krJ__-._-� ��Ql� __________ Water Supply: Public system J, Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam' Clay ❑ Adobe off Hardpan Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No [-]3,&/y lelp,P7t,p,eA �/AUV.#i( TYPE OF INSTALLATION AND SPECIFICATIONS: A [[ '' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic_Ta ` Distance from nearest well.................Distance from foundation__-_-_..._--_--_.Material ._.___._._...._.__....._.-.......--..._- r— 5 I ,$ t nq No. of compartments----------- -------------Size--------------------------------Liquid depth--------------------------Capacity-------- -- Disposal Field: Distance from neajest well_X ----Distance from foundation...-1.Q..._.....Distance to nearest t line-_._-.-'--_- Number of lines...1........__ Length of each line. _11_'--------------Width of french..... �, 00 Type of filter material..f..-�_.. -------Depth of filter material..---18'_------_----Total length..:�f�------------------------------ Seepage Pit: Distance to nearest well -.._.-__. Distance from foundation....................Distance to nearest lot line-..--...._-.__... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------- Cesspool• Distance from nearest well.................Distance from foundation---.-------.--------Lining material_..__..-.._-..--_._.._-.._..-..--.-_. ❑ Size: Diameter-------------------------------------Depth----------------- ----- ------Liquid Capacity--------- - - gals. Privy: Distance from nearest well-------------------------------------- ----------Distance from nearest building-------------._ ❑ Distance to nearest lot line_..............._._..•_--_....••---._._•_-____ Remodeling and/or repairing (describe): •--•-----•-----------------------------••- C4 -----•------•-----------------------------------------------------------•----------------•--------------------•------•------- -------------------------------------------------- -----------------------------------------------------------------------------------------------•-------------........................................... --------------- �o I hereby c ify that I have prepared this application and that the work will be done in accordance with San Joaquin County — ordinances, S t laws, andru s and regulations of the San Joaquin Local Health District. (Signed)........ . . ------------------------- -------- ---------- -.. Contractor BY: ............................................................. A Z ---------------(Title) - - ) --------------- (Plot plan, showing size of lot, location of system in elation to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------ ---- ---------------------------------------------- DATE REVIEWEDBY------------------------------------------------------------ -------------- ---•- DATE------. --- •------ ------ -------- ----------- ---- BUILDING PERMIT ISSUED-------------•--••-----•-----•. •-•----••-•-••---••--- DATE--------- Alterations and/or recommendations: --------------------------------------------------------•---------------------------------------------------------- -----------------------------------------------------•---- --------------------- ----- ----- ----- - FINAL INSPECTION BY:..- -..__._. ------------------- !-'•-CZ------- 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-2100