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31 v� APPS r � � KATION FOR SANITATION PERMIT Permit Na. --3--/-•-ti.—I__ �J fE (Complete in Duplicate) r 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. JOB ADDRESS AND LOCATION _ --•- -#_60# _;X. Owner's Name----------�•------------- -------------------------------- --- Address------------------ ` - one-_---------------------------------- �.�- ' Contractor's Name______ _ _ _ ____4____�_ - _ ___ _ __ __ r Installation will serve: Residence - ---- ------------ --- --- - -="� �-_. Phone--�_;; • ---� - Com' Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms - . Number of baths ---J_ Lot size __- Water Supply: Public system pP Y� uy ❑ Community system ❑ Private epth to Water Tab[ e�� ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ a Loam Clay Previous Application Made: Yes ❑ No ❑ New Construct' y ❑ Y ❑ Adobe Hardpan ❑ Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dis#ance from nearest weii----------------- Distance from foundation-------------------- -----------_---- ❑ No. of compartments--------- ----_---'_-Size-_--___ Liquid depth .----------------- Capacity --------------- isposa field: Distance from nearest well_ --__ -_Distance from foundafio Q __ ---__---.__-Distance to nearest lot liI--�- Number of lines---.�__- ----__ _- -_ Length of each line--- -_ fs g _YZd--.Width of trench_-------__ Type of filter material-�� ---------------_ -�--Depth of filter materia--_. -. -__ / ��----Total length-------�9�--�----------------Seepage Pit: Distance to nearest well----------------------Distance from foundation__------_____-----.Distance to nearest lot line_-.--_-_-❑ Number of pits.-----------------_---Lining material---------- --- -Size: Diameter------------------ - - ---[?epth_--------- ---------- - esspool: Distance from nearest well-----------------Distance from foundation-.-.-.------------_ Lining material.-------_-----_________ --------El 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)-------------------_ ' -- 1 ?/ -- ------- _ - - -- -- - -----•------ ------- - -------=-------- ------------------------ ------ I hereby certify that I have prepared this application and tha the work will be. one in accordance with San Joaquin County ordinances, State I an rules and regu tions f the San Joa uin Local Healt istrict. {Signed) �-- -------- -------- -- -------------- -------- -- ----------- (Own or C tractor - ---------- __ BY: -.r..--- ----------- ------------------------ ) - -------------------• (Title} �. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r PARTMENT USE ONLY APPLICATION ACCEPTED BYREVIEWED BY -_---_--_-._ ------------------------------------ DATE----:�_?_ �� -.•- - ----- ---- DATE ---------------------------------------------------- UILDING PERMIT ISSUED_-. --------------------------------------- Alterations -------------------------------------- •-•------------------- - --------------- DATE----------------------- A terations and/or recommendations.--_.--.-.-.----_ - ---------------•--------•------------ rt-,v----------------------------------------------------------------------------- •-------------------------------- FINAL INSPECTION BY------------------1K -- -- -------------------- Date------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California �.recy, California ES-9-2M 10-52 Revised W-2100