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SANITATION PERMIT Permit No.✓-9-3 .-� . . APPLICATION FOR . - .. (Completein Duplicate) 5 "S 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-------------° l-c?._ ----------� - Owner's Name-------------------- --------- _ea�1 •-------...Tm- ----------------- ----- Address............. -------------------------------- ---------------------- --------- I Contractor's Name... = ='------------------•-------------..------•------------------------------------- Phone----------------------------------- Installation will serve: Residences A Apartment House El Commercial E] Trailer Court E] Motel El Other ❑ Number of living units: -------- Number of bedrooms_ . Number of baths ----!___ Lot size ______ _____115.0_'------------------ Water Supply-' Public.system ❑ Community system cPrivate ❑ Depth to Water Table __ _ ft. ' 1 I Character of soil to a depth of 3 feet: Sand I] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes E] No t New Construction: Yes g] No ❑ .` TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tanVE or cesspool permitted-if public-sewer is available within 200 feet.) Septic Tank: Distance from nearest well______.-t---Distance from foundation-___.b Material (.yc No. of compartment`s----------Z---------- q-------Liquid depth--------�_L` &pacitY------ 'd------ Disposal Field: Distance from nearest vell-._.,50-------Distance from foundation,___10-------- Pistance to nearest lot line____-6 --______ Number of lines___13_____________ Length of each line-A-0;-(�?..,- _.Width of trench..... Type or' filter ma-i•eof filter material......,1._gfC-----Total lengthf------- ---,___ _ __ Seepage Pit: Distance to nearest ell__--------------------Distance from foundation--------------------Distance to nearest 4ot line__.____.________ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter----------------------:Depth---------------------------------- Dis�ance Distance from nearest well----_------------Distance from foundation------------------- material___.___:___.__._----.-__--.._._______- ❑ Size: Diameter-----7- `---------------------------Depth----------------------------------------------------Liquid Capacify----------------------------gals. Privy: Distance-from nearest well-------------_-----------------------------------Distance from nearest buildings------------------- ❑ Distance to nearest lot line----------------------------------------------------------------------- - I Remodeling and/or repairing (describe):---- = -•----------------------------------------------------------•--------------------------------------- ----------------------•--------••------------------------------....---------------------------------------------------------------------------------------------------------------------------------------------------- ----- I I ------------------- --------------------------------•----------------- -----------------------------------------•------•-----------•-------------------------------------•-------------------------------------------- -- 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. (Si ned g )- - . _ ... __ _ -- - - -----------------------------------------------------------____--(Owner and/or Contractor) { .`: (Title)--i' g ' (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD ART ENT US ONLY It Z7 _< APPLICATION ACCEPTED BY- _ f f ---------------- DATE---- g REVIEWEDBY-----------------------------------------`--- -------------------------------------------------------------------------------- DATE---- --------------- BUILDING PERMIT-ISSUED.----------------- I----------------------------- ----1------------------------------------ DATE Alterations and/or recommendations:--- ----- ----- ----------------------------------------------•—`----------- ----- ------------------------------------ �., i { _' ------------------------------------ --------------------------------- S..' T I. .I - a - ________________________________ _�_ � _-_-------` ---------i-_--_._-..----__...______.______________.________.______________.__._____.__-._-______-_..___________________..___.._-.- .. _. _____________________ _________________________--------------- ------- __-____.____________.__.___.__.______...______________._._____..-_____.--_-__________.___-__.____..._____.____.____.__-..__._.______ FINAL INSPECTION BY:.---------- -•- Date- �'7 tom' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Re,ised W-2100