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Permit No. ------ .' 3 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued __0_._____•-------- -3 becl- is hereby made to the San Joaquin Local Health District for a permit to construct and install� o�}� herein esEri ApplicationY j �,r/�ia,t 1 This application is made in compliance wit County Ordinance No. 549. /f JOB ADDRESS AND LOCATIO Phone - rTYl� �� `� --- --------------- ------ ---- - --------------- Owner's me- - ------------------ ---- ----------------------•--••- Address.__.:_ '� Phone---- -- Contractor's Name------------------------------ Commercial ❑ Trailer Court El motel ❑ Other [:1Installation will serve: Residence � Apartment House ❑ Number of living units: Number of bedrooms .. "" Number of baths ._.,f_ Lot size ___— --- Private Depth to Water Table -------- ft. Water Supply: Public system F-1Community system El �- Adobe Hardpan C]Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam_, Clay Loam [I Clay ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest welly:5" - - --Distance from foundation_ -------------- • ` Ca acit "_Siz � -- ------- Liqu,d,depth---��---------- No. -'------ p Y•-- - No. of compartments_,---- -- - �"�.Distance to nearest lot line._ Disposal Field: Distance from nearest well 0------Distance rom foundaer tion_____ - Width of trench_____ -R� Length of each line_-____-7_..T - . " Number of lines. ------ :� t g it Type os filter mater'sal___�"�----!`-�--Depth of filter material------- -----Total length___.��------ ------------------ Type -------- -------- , ------------ Seepage Pit: Distance to nearest well -:Linin material efrom foundszienDiameter_- ---stance to nearest lot line Number of pits.--------------------- 9 Cesspool: Distance from nearest well___-_"_._-_._-___Distance from foundation_____________ `Lilnui.d Capacity gals. ----Depth----- ----- -------------------- _ -------.-----------�-M ❑ q p ' Size: Diameter---- ---•--- ------ ------ --- �._�T_�_�------ , -� � _ "*`� "Distance from nearest building-_ .. _� privyc Distance from nearest well_7"' -- - Distance to nearest of ine_�---------------- --- ---------------------- 11 Remodeling and/or repairing (describe}__ _____________________- _ ------------------------•----------------------•---•------...---•-- ------------------•--------------------- ------------------------------------------ -------------------------------------------------------------------- -1----------------------- -- --- ••---------------•-------------•---------------- ------•-------------------- lhereby certify that I ha. a pr pared this applicati n and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and les nd regulations of th` S n Joaquin Local Health District. s j r„�rrdScaCs Co racto f (Signed)------------------------ ------ /t./Lcs� ----- Title __ _ � -� ( ) (PlotIan, showing size of lot, location of s s in relation to wells, buildin f!a+c., can be p1 cad on reverse side]. � r r FOR DEPARTMENT USE ONLY = ' = DATE-------------�F ' ,�3----------------------- APPLICATION ACCEPTED BY------------------- -- - -- ---------------- DATE--------------- --------------------------------------------- ------------------------ ------------------ ---- ----------------- BUILDING PERMIT ISSUED----------------------------- --------------------------- --- Alterations and or,�ecomme dations: "- 1=—N------- ---•--------•-----------•-- x-e - Pte--)--------- -------------------------------------------------------------------------------------------------------------- --------------------- ------------------------- ------------------------------- _ t ------------------------- Date.... --�-f ----- -/--------- -- --•----- FINAL INSPECTION BY:.------ ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Lodi, California Manteca, California Stockton, California ES-9-2M 10-52 RevisedW-2100