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APPLICATION FOR SANITATION PERMIT Permit No.a�7:- --------- (Complete in Duplicate} Date Issued _--/-�- /j Applicatia 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. JOB 'ADDRESS AND OCAT N - ------ - ---- 4-------- - - -------------------------------------------------------------- P Owners Name--------------- ---Z70i.---- - --------- ------------�_--- Phone _. .._.... — Address ---! c.. - ---- ------------------------------------------------------------------------------------------•------ _ f Contractor's Name-.---- , --- 1 Phone /� -' _-41 Installation Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-- - N er of bedrooms ._l_,_ Number of-baths _ __ Lot size �-a--A__ --d '�---- ---- i Water Supply: Public system Community syst n Private ❑ Depth to Water Table/-6 ft. Character of soil to a depth of 3 feet: Sand Gravel [-] Sandy Loam E] y Loam E] C14 El Adobe Hardpan [1 1} �4 Previous Application Made: Yes E] No New Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F ( p p p p (.-... is available within 200 fee+) No se tic tank or cess ool er f It+ede f ublic se per �.- T� _L "�- - --- --------- Distance Septic Ta from nearest �� tante from foundation__/'___,______.-_.Mate A ,. ._. . . No. of compartme l Fs----- ze----1� - 5 ----Liquid `U/d�th---_)tel---t =-----Capacity_---�--------`--- ! ,f Distance from foundation_Y1T--__-_-._._.Distance to nearest lot hne__1a__-_._.. Disposal Fi d: Distance from Weare t wellll�du _ ❑ Number of lines____ .__ _ _ _ Length of each line___Vj_d-r______________Width' of t e.n.chf___ g T Type of filter material -_ __ __- � Depth,of_filter material-_________._Total 1. g h______ 3 k r Seepage Pit: Distance to nearest well----------------------Distance from foundation____-_____________.Distance to nearest lot line----------------- Number of,pits---------------------Lining material-----------------------Size: Diameter-------------- ---Depth-------------------------..-----• Cesspool: Distance fz-om nearest well-----------------Distance from foundation---------------;---Lining material__._-_--___-_-..________--_______.___. ❑ Size: Diameter---- ` Depth { --------------------------- ------------------ - '_Liquid Capacity - ---------gals. _..:.. Y Distance to nearest loft line--------------- -._--- -�------------ --------Distance from nearest building_____-_._________________________.____. Priv � Distance from nearest well______'__.___-_.._ ❑ , - f Remodeling and/or repairing (describe):------- -- - j----- ---------- ----------- "' ,,, -------------------------------- --- ------------------------------------------------ --- --- -------------------------_-------------------------------------------------------.--------------------------_-_________-___________-___________-_________-_______.________f____________.--______-_-_________.__.-___,____..._.._ I hereby certify that I have prepared this application and that f9e work will be done in accordance with San Joaquin County ordinances, State law , and rules and.regulations 'of the San Joaquin Local Health District. �s i x Y•G2 lar x--(Owner and/or C tractor (Signed).. i -- -- - --------------•------------- -(Title)------ By:------- — "------ '-------- -- (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATIONACCEPTED BY--�- ---------------------------------------------------------------------------------------- DATE—V—_--------------_----------------------------------fit -- BUILDING NG PERMIT ISSUED - - - --- TE - - --------------------- U Alterations and/or recommendations _______________________ i ------------------------------------------------------------------r - d � -- --- ��---- ------- -I-iA-C--- ---C=- h ------ -•- -----' • t ---------- -- --- ------------------------------------------- FINAL INSPECTION BY:----- ---- - ---- -----=------------------------- Date-----------3 ! i SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES-9-2M 10-52 Revised W-2100