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V�. APPLICATION FOR SANITATION PERMIT Permit No. ..3-- (Complete in Duplicate) / Date Issued _n1_1 - y Appli ation is hereby made to the San Joa uin Local Health District for R a permit to construct and install the work herein described. This a.plication is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION.1al ili"l, 6P--of &/� el%--)Q}�� 7_ t *�` - � " - ----------------------- yy Owner's Name �ft ------------------------------------ Phone Address---.----------------------- Contractors Name... --------- _ Phone •Q -4 ----------------------------------- ----- Installation will serve: Residence Apartment House ❑ Commercial F1 Trailer Court p Motel ❑ Other ❑ Number of living units: -- -_ Number of bedrooms ---1--- Number of baths ------- Lot size --_ --,- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table -dfgf ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes X 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 wel1_1413'U---_Distance from foundation--_/53-Q_ --.Material---. ✓ _- ¢? __!",:cC, 5 No. of compartments----1�---------------Size__Z ---.---Liquid depth__ _-------------Capacity- /OD_-- -- ��Q., --- Disposal Field: Distance from nearest well'----Distarfce from foundat'on-A-O r------- line----lines---- --------------------------- Width of trent .-..-- -V" Type of filter material-_�-�i __--Depth of filter material-___---1_+ .�' ------------------------ ----- Total length---- - .--------------------------- —s Seepage Pit: Distance to nearest well---/GYS___ -------Distance fror$n foundation--k_x-`-___Distance to nearest lot line--_--��_-_ _ 19 Number of faits----]------------- Linin material��"_ --- g � -1 -.size: Diameter---'�-J..........Depth---�-' - �-----------i Cesspool: Distance from nearest well-----------------Distance from foundation__.--------------_.Lining material---------------------------------Size: Diameter--------------------------------------Depth--------------------------------- -----------------Liquid Capacity -------- ga Privy: Distance from nearest well------------------------------_---_-_----.-.___-Distance from nearest building--_ ❑ , Distance to nearest lot line ,--remodeling and/or repairing (describe)------------------------------------------------------------------------ -- -- -- - --------------------------------------------- -- --- I hereby certify that I have prepared) i application and that the work will be done in accordance with San Joaquin County (� ordinances, State laws, and rules and re, lati ns of t e San 4oaquin Local Health District. ` (Signed)--------------- ------ ----- ----------------- �- 6 y l 'Ut,- ( +!��Contract -- -- or) By: -----------------------------------------------------------------------------------(Title)---- " -r•*a . l r F x (Plot plan, showing size of lotf.location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ HATE/,.2-_.' �� _ ---- --- -------------------- REVIEWEDBY------------------------------------- - ------------------------------------ DATE BUILDING PERMIT ISSUED------------ ------ ------------------------------ ------------------------------------- DATE -- -------- ----------••------- Alterations and/or recommendations:-------------------------------------- -------------------------------------••------------------- •--------------•------•----------------------------------- -------- -I----•------------- "----------------- ---------------- FINAL INSPECTION BY:------------ -------- ----- r Date- ----------------------------- ------ ------ -- ------- �------ ----------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 136 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 0-52 Revised W-2100