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k •� APPLICATION FOR SANITATION PERMIT Permit No>...s2--7...��__. q (Complete in Duplicate) Date [ssued -- ------------------ - Y .Applica+ion is hereby made to the San Joaquin Local Health.District for a permit to corVt ruct jpd install the Zprk herein described. This application is made in compliance with County Ordinance No. 549. `�p 5 C //�( � •l JOB ADDRESS AND LOCATION./[d___:7a__=-/6-_47---- V #1---------4r----- h1 �-�'- ...._.. Owner's Name ------- !°� `---------------------- a� (i.......i- er-l]&M--4S----------------------------- -'------------------- ------ Phone---------------------- Address - - = ' == --------t----------------- ----------------------------------------------------- ' lig- 1 Contractor's Name 'W."`� = -- = ---- ---- --------- Phone. ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail�/r Court'❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __'Number of baths __!,!4 Lot size _____/f1'4____ ___JSS! Water Supply: Public i y`stem Community system E] Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 4Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( Hardpan E]Previous Application Made: Yes ❑ Nom New Construction: Yes No F1 �l TYPE OF INSTALLATION AND SPECIFICATIONS: t r F 1 (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) f �J . . - Septic Tank: Distance from nearest well l � Distance from foundation 1.4 � Liquid dMar ��- Coaa/ No{ of compartments-------- ----_-- ----Size-----: ---- q pth__ P Y j Disposal Field: Distance from nearest well__NQ______Distance from foundation-----1_0________-Distance to nearest lot line----------------- Number of lines____________ Length of each!line_1Width of french._________z __ Type or filter material--------JY............Depth of filter material------1.!� _ __ __._____Total length.- ____ � __ ' See a Of Pit: Distance to nearest well-------_�/Q-------Distance from foundation------t&'_____.Distan ce to nearest lot line___ Number of pits--------#-------------Lining material ___.Size:•,Diameter-------c1-6._-------DeP�h -P�.-�`-�,/-- -�--`----- ---�. Cesspool: Distance from nearest well__________ ______Distance from foundation............... material------___________._________.____._ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from,nearest well---------------------------------- --------------Distance from nearest building-----.---------------------------- ❑i Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------- ------ Remodeling and/or repairing (describe]-----------------------------------------------------------------------------•------------------_---- -----------------•-•---••----------•------------------------------------------------------- ----------------------------- 1 --------------•----•----------------------------------------•------------ -- I 'hereby certify that I have prepared this application and that the work will be done in accordance with'San .Joaquin County ordinances, State laws,--and rules and regulations of the San Joaquin Local Health District. i s Sined ------------------------------ --- - Owner and/or Contractor __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 SY---------------------------------------------------- - - - DATE------- `` DATE--------------------------------------------------- REVIEWED BY....�'------=------------------------�--=--•-=----------•---•-------•------- �--•-------�--•-....................... -------- BUILDING PERMIT-ISSUED-•-....---._..."------•-----------=-----------------------------------•� ---------------------------• DATE-----------•------•---------------------------------------- Alterations and/or recommendations:-_-.-----._..____ _ w 'F -----------------------•--•- -- ------------------------------------------------------------ ------ ----------------------------------------------------------------------•----•------------------------------- - ------------ -------------------------------------------------------•--- -----------------•------- -------------• -------I•--.. .. •---. ------ .. -----. --•---------------------- ----------------- --------------------------------------------'------------------------- F T • FINAL INSPECTION BY------- --------- --------------------------------------------- Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT a , - 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 Revised W-2100