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.sem- x ✓ APPLICATION F —)SANITATION PERMIT Permit No. _.. . (Complete in Duplicate) / Date Issued .Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i chis application is made in compliance with County Ordinance No. 549. ----- fi "'"JOB ADDRESS AND LOCATION_._ �.a- IL �- ...- —4f Owner's Name___ - --- ---- ------- 1 -'! .'C./ 17 - Phone u� - 1 Address------- ----- --- I--------- --------• --------------+ ----� d--, - =----'-----------_ ------------------ - � .. Contractor's Name---- ----1- - ----�--`--------`-----------------------------------------------------------------------------------------------•- ------ Phonej�_o,_ Installation will serve: Residence POO`Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel IOther E]Number of living units: ___i-- umber of bedrooms --'2*-- Number of baths ___j'-__ Lot size __ _ __t__ ______________________________________ _,• Water Supply: Public system VCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2f Hardpan ❑ Previous Application Made: Yes [❑ No Rill," New Construction: Yes 9'No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: �. (No septic tank oir cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: v Distance-from nearest well-----------------Distance from foundation___________________Material------------------------------------------------- No.. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------- --------------- Disposal Field:. Distance from nearest well------------------Distance from foundation-------------------.Distance to nearest lot line__..__.-___-_--- i yupmber of lines-----------------------------------Length of each line--- ------- •__.Width oftrench.----------------------------`---- T e or filter material-_____._1--- __ _1Depth of filter material___-0g . __Notal length------------------------------------------ Seepage _________________________---IQ-�-,_ Seepage Pit: Distance to nearest well________ ,__ Distance from foundation _____ _________.Diss ante to nearest to line_______._.. � Number of pits------R______-__--_-Li ung mate rial__�__.Size: Diameter----.3.1� 3 __.Depth.... - -- --- -�- �- �� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------- -------------- ❑ Size: Diameter---------------- ---------------------Depth--------------------- _Liquid Capacity----------------------------gals. ��rw r", 171 Distance from nearest well--- ------- - --------------___.______________Distancerom nearest fbuilding �N g-----------------------•----------------� • VJ ❑ Distance to nearest lot line ----------------- --------------------------------•------ -------------------- ---------------------- ------------- - - - Remodeling and/or repairing (describe):---- - 4;0a` V'---'•--------------- - ------ - --------•----------- ------------ --------------------- --------------------••---------------------•-------- •-•------- ------- ••----•-- 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. (Signed)------ ----- ----'---- -------------------------------- ---------------------------------------------- -------------------------(Owner and/or Contractor) SY= -- --------------------------------(Title)---- .'!`------—�--------------------------- (Plot plan, showing size of, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- --------------------------------- --------------------------------------------•-•----------- DATE 1---------------------------------------------------- REVIEWEDBY------------------------------e--- --------------------------------- -------------------------------- ------------ DATE---F`------------------------------------------------- BUILDINGPERMIT ISSUED---------- "�------------------ -------------------------------------------------------------- DATE.-_17------------------------------------------------- Alterations ATE•- --- ----------------------------------------------- Alterationsand/or recommendations-------------------------------- ----- ----------------••-•------------------------------------------------ ---------------------------------------------- --` -----------Ao_.r su ,..._....bm_ 1.� ,----- Io -- -----.s� 4�Q. r z.► c ►�----• •..2... enam -- _ � ' ! -- FINAL INSPECTION BY: = --- ----- Date-- 4c !�`-----------------•---- 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 Revised W-2100