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APPLICATION FOR SANITATION PERMIT Permit No. J i (Complete in Duplicate) Date Issued cation is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. Appy This application is made in compliance with County Ordinance No. 549. ' f - --- ---- ---- JOB ADDRESS AND LOCATION ---- -. :__ - -- - --' is ------ -----�',� - -------- ---------- - ------ ----------------- Phone------------------------------------ Owner s Name---------�:��.a._-�!�—---- >. ------ ---�j_- - --- -- -- ------------ - ------------- Address..------ `�_ •-------- ---- ---- -- �� (- Contractor's Name---- ,r'� � _-_ -f' -----1 �----1:6�• r -------- one j Ph f� _ Installation will serve:' Residence [ -.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . ---- Number of baths ---1�--- Lot size __-- ---�Q-/��----/� Number of living units: _-�_-_ Number of bedrooms � - ---------- Water Supply: Public system 9,<51mmunity system '❑ Private ❑ Depth to Water Table '/ft:,- a de th of 3 feet: Sand '" Grave{ ElSandy Loam -'Clay Loam ElClay ❑ Adobe Hardpan ❑ �I Character of soil to p Previous Application Made: Yes F1 No M%ew Construction: Yes.[A No ❑ -- -~" TYPE OF INSTALLATION AND SPECIFICATIONS:" (No septic tank or cesspool permitted if public sew.er is available within 200 feet.) ox --.Material----- ------- - -- Septic Ta Distance from nearest well `�.f Distance from foundation_-�--�-_~__-__ �—qij. ( _ No. of compartments--- { Sze ! --- ----------Liquid depth.- Capacity ----- f� ,,��"//E}``bAu _ ___Distance to nearest lot line----------------- Disposal Field: Distance from nearest well_C�----____-.-_.Distance from foundation__L��_____ Number of lines-_°_ _ ,__ __-- _Length of each line___-a_C _ ---6i1 Width of"trench------ -.__ --------------------- ,rr'---sDepth of filter material---- --_--------_Total length ------------------- . Type of filter material _ - - Seepage Pit: Distance oto f nearest well --fining material Distance from foundSizle:nDiameter-- Distance toDepthst lot line----------------- Seepage -=------------- ❑ p -------------------- Cesspool: Distance from nearer} well--------_____--_Distance from foundation--- Lining material------------------= alsI Size: Diameter.--------------------------------------- Depth---------------------------------------------.-------Liquid Capacity----------------------------9 Distance from neaiestiuilclin" Privy: Distance from nearest well -------------------- -------g--------- ---------------- ---------- Distance to nearest lot line------------------------------------------------ ------------- r ❑ -------------- I r ot4 Remodeling and/or repairing (describ)]:----------- ----�--------------- I ---------•-------------------------•----------•------------------- r __ _ -------•--------------------------------•------------------------------------------------------------------------•------•-------------------------------- 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 Joaqui Local Health District. -- ` dd;------------------ or Contractor) (Owner an (Signed) d i q Title '- ________ � W. L__ �1 u ----------------{(Title) --------------------- k pan, g t y ion to wells, buildings, etc., can be placed on reverse side). Plot Ian, showing size lac, location of system in relation , 4 FOR DEPARTMENT USE ONLY 4 ACCEPTED BY -- ------- - ------------------------------------------------------------------ DATE--- ----- ---- DATE-----y i�---------------------------------------------- APPLICATIONREVIEWED BY - ---------------------:------------------- R { BUILDING PERMIT ISSUED--------------------------- -- DATE - i. Alterations and/or recommendations----------------------------- -------------------------------------------------------------------------------------------------------------- i --------------------------------- -------------------------------------------------------------------------------- - ------ -------- ------ - --------- ----------------° -------------------------- ------------ -------------------- _ __ ___ ------------------------------------ ------------- Date----------- .f - ---------------------------------------------- FINAL INSPECTION BY---------------------- -------------------------------- SAN -- ------ 1 SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street' 814 North "C" Street - Lodi, California Manteca, California Bracy, California Stockton, California } w I ES-9--2M B-51 Revised W-2100