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^. .. fiQ7 APPLICATION FOR SANITATION PERMIT Permit No. ._.l-_ _-r/_--7._... (Complete in Duplicate) r 7 f Dare Issued ----:-«/__�-,-- Applicalion 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. 544. 1-73 — 2-6z-1`3 JOB ADDRESS-AND''COC' w 1 o ± ---------- Owner's Name___��, r__-__.- j -------------------------------------------------- ------------------------ ------ Phone---- Owner's C.2- je Contractor's Name -- --------'-- ------ Phone------------- Installation --Installation will serve: Residence ❑ Apartment House ❑ Commercial7RD— Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size --- _ e - _.- Water Supply: Publicsystem 2&—Community system Private El Depth to Water Table �L�ft. / ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe*D§, Hardpan ❑ Previous Application Made: Yes ❑ No E New Construction: Yes 1 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------l��.istance from f oundation_,'7-4)-_f_____.Material-___ No. of compartments_.. + . __. Size----- de --�------Capacity_._� d7i� Disposal Field: Distance from nearest w.•eil_ &0,7% Bistance from foundation___.®_..._.__.Distance to nearest lot line---AG---k �_ Number of lines-----_----/---l----------------Length of each Iine_4 _-_&V4---'__...Width of trench---.-- r� Type of filter materia!____r_ --_ Depth of filter matenal__,_Z_,�__- ------Total length-______ o -------- Seepage Pit: Distance to nearest well--- _'t`_ -Distance from foundation-----11!�Pe_1_._.Disfance to nearest lot line---- d___r_ Number of pits____..r. ,.______Lining-material.____raq� .C_-Size: Diameter._.__ -��--__Depth__,..- -!!V _ � Cesspool: Distance from nearest well-----------------Distance from foundation__`--------------- Lining material__=._-.____.._ ❑ Size: Diameter- -- ---------------------- ----Depth------------------------------------------- --------Liquid Capacity---------- -----------------gals. Privy:" >' Distance from nearest well________________---------------------------------Disfance from nearest building-------------.---------------------------- 7n] ❑ Distance to nearest lot Jine---------------------- ------ --- = ------- Remodeling and/or repairing (describe)---------------------------------------- _----•--------•---}--------- --•------------•--••---------------------------- --••---------•-------------------- ---------•---------------------------- ----------------------------------------------------------------------------------------------------------------------------J------------------------------------------------------------------------------------ ` . � ----------•----------------- ---------•------••-------------------------------------------------•-----•-----------=------------------•------------------------------.------ 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. --- ---- ° ---------------------(Owner and/or Contractor) $ ' �--------Z� - - - - + - -------------------------(Title)-------- ----------------------------- (Plot plan, sowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ° FOR DEPARTMENT USE ONLY - r APPLICATION ACCEPTED BY--------------- ----- ----- DATE---------- ------------------------------------------- ----- --- -------------------------------- REVIEWEDBY------------------------------------------- -------------------- --------------------- - -- DATE------------- --`------------ Bl11LbING .PERMIT ISSUED ---- =' DATE r Alterations and/or recommendations--------- -------�fz� --tom,------------ _ -- - ---- A _ ____________ _____ .._____._____. .______.. --------- ---- --- ---- --- ------------ 1NSPEFNAL TI ~ Date ------- --------- 7—/2 ` SAN JOAQUIN LOCAL HEALTH DISTRICT > 130 Soufh American Street 300 West Oak Street 132 Sycamore Sfreet � 814 North "C" Street Stockton, California Lodi, California Manteca, California �AOT raey, California Es-5 .ikse nrwovo 2