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�.. FOR SANITATION PERMIT Permit No. _/___--------- APPLICATION (Complete in Duplicate) 9 - 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. T � ,y JOB ADDRESS AND LOCATION ----------- �' 're f• may/ _ Owner's Name---------- r- � >•' --------------- Phone------------------------------------ -------- Address----------------------- '; -. --------� � ? - '_--- _�- r Contractor's Name--------- -- --_`_: � -� /� !�_ �_1 ----_-- Phone__ __ _N Installation will serve: Residence [f]" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!-___ uf5ber of bedrooms r"-__ Number of baths -/- Lot size ______� ,_ __ _ U_____________ Water Supply: Public.system [ Community system -❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑iGravel ❑ Sandy Loam^ ay Loam El Clay El Adobe©� Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes Rf No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer,is available wifhin 200 feet.) Septic Ta k"__ Distance from nearest wel} ZDistance from ' fo/u'n-dSartion_f-U ------.Material- �� - - r ---- e---Irqp � -----No. of compartments-----t7-------- S- Liquid d r--. Disposal i d: Distance from nearest well��4*01fa- nce from foundatilog-Z:ST---------Distance to nearest lot line__0_-_____ Number of lines___f`___________ _ ___ Length of each line--_ f- ---------------Width of trench___ Type of filter matenal_� G'?� -f_-/Depth of filter material_-l_a_____________Total length_______ ___________________._ Seepage Pit: Distance to nearest well __-Distance from founiJation_1d_----------Distance to nearest lot line_ _____ Number material__f�_'e,&_Size: Diameter___u__,�_-------------Depth----- ?_v----------------- —s4� � Cesspool: Distance from nearest well-----------------Distance from foundation___________________lining material________-________-_________._______--. ❑ Size: Diameter--------------------------------------Depth-----------------t----------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest'well-----------_______F___________-______._____-__.Distance from nearest building__________.-------.___________._____--___. ❑ Distance to nearest lot I;ne----------------------- --------------------------------------------------------------------------------------------------------------------- i 1 Remodelingand/or repairing _______-_ - f _ Lr` -------------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws,,and rules and regulations of the-San Joaquin Local Health District. ��`,�- --- ._ d �- �G I (Signed)----•--------�--!�-�,�-- �1 - -�� -..�% � �f`-------------------,:•----(Ownand/or �ontractorJ • =--�/ --------------- ----------- ----------------------- Title--- llr :?� _ '-� BY•------ — = -- { ) ----------- (Plot plan, showing size.of lot, locafion of system in relation to wells, buildings, etc., can be placed on reverse side). i � f FOR DEPARTMENT USE ONLY � r r APPLICATION ACCEPTED BY ' -' f-------------------------------------------- DATE I `{ �—' REVIEWEDBY------------ ----------------------�-- -------------------------------------------- DATE------ ----- --I------ U ---------------- BUILDING PERMIT ISSUED------------------------------------- ------------------------ -------------E------------------------ DATE--------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------r - ------------- --------------------------------------------------------- - FINAL INSPECTION BY:----- VI V-iQ---------------------------------------- Date- -- _` 0 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 8-51 Revised W-2100