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APPLICATION 1=0R SANITATION PERMIT Permit No. (Complete in Duplicate) Q 3 Date Issued .._�_t 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. x JOB ADDRESS LOCATION__ , t----CP(R_1V-0,P-----_- .� �-�--- ?—,S 7W I?'r i/i/W'r 7-.A- 146 tap— I ' Phone --------------Owner' Address -I �1-.� hE�a f ----------- - ---------------------------------- ------`-�-_- �- - Phone_f ��Contractor's Name_ ----- Installation will serve: Residence R, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living umber of bedrooms _ units: _a,�,N A_�___ Number of bathsI----- Lot size ;��-�-----�---a--��J---------------------------- � Water Supply: Public system ❑ Community system '❑ Private X Depth to Water Table 4S, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: Yes ❑ No xNew 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 well________________Distance from foundation--------------------Material----_____-____________________._________________- m ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_ `___.Distance from foundation___ 1 • Q_ _____Distance to nearest lot lme. .___--.-- Number of lines---47%esPP-----------------Length of each line___.4�0_`______«_____.Width of french -f_____________--___ Type of filter material __ D ._Depth of filter material-___---IS-1_------Total length-----_((r�?Q----------------------------- Seepage Pit. Distance to nearest well___- 7-W---------Distance from+� fIoundation_.40.........Distance to nearest lot line___ ___________Oj _ 2�___-Size: Diameter__'�7_� Depth- __ f Number of pits-dY_.4---------Lining material---& ------ P �� i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________________________________.. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity.----------------------------gals. `Privy: Distance from nearest we1L___________----------------- ------------------Distance from nearest building-__- -_, ___.-._._. ____________. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):- •-------- --M -----------t------------------- ---------- _0Z -------------- - �c -------- ,1.�, , �-=�' -f------------------------ -------------------------------------------------•---------------------------------� ==----------------- 1--------- ---------------!!------ ---------- ---- ------ �� ------------------------------------------- --------------------------------• .� x I I hereby certify that I have prepared-#s application and that the work will be done in accordance with San Joaquin County I ordinances, tate laws, and rules and egulations of the San oaquin L al He IthgDistrict. ____- ____Owner and,or Contractor M1 } ------------ - - ---�--- ---------- ----- --------------- (Signed - [ / I Plot Eon, showing size of lot, location of system relation w�f T _�Iff.�• ,_ ________[TitEe}_____�_Y-.f - —�% 0'1 B --- --• --, f Y' s' 1 ( p g y ells, buildings, etc., can be placed on reverse side). x FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY________________-_--_----_----------_-- -SZ _ DATE---------- �---�- "°-j------------------------ REVIEWEDBY--------------------------------------------- -------------------------------- -- ------------------------ --------------- DATE------------.------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- ---------------- 1 Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- { ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------•----------------------------------- -------------- --------------------------------------------------------------------- -------------------------------------------------------------------------- tl _ FINAL INSPECTION BY: V-- f-- ---------------- Date.- g �"' SAN JOAQUIN LOCAL HEALTH DISTRICT ii0 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100