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.�-- y APPLICATION - FOR SANITATION PERMIT Permit No.-4---6- - '7 (Complete in Duplicate) Date Issued W r )ApplicaZin is hereby made to the San Joaquin Local Health District for a permit to construct and install the wdTk herein described. Thapplication is made in compliance with County Ordinance No. 549. � ---------------------- .JOB ADDRESS AND LOCATION_______________ rmac , Ct rQ r Phone------- ------ e , ,liU- --------- ---------------------------------------------- ------------------ ------------------•--------------------------------- Address---------------- ' 7� 1?.+'a 17- --------------------- Phone Contractor's Name---------------------------- ------ t Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _L-._ Number of bedrooms _ _ Number of baths __`___ Lot size _________________ ��-a------------------------j ! Water Supply: Public system Community system ❑ Private ❑, Depth to Water Tablh_-,-v ft- Character of soil to a depth of 3 fee+: Sand ❑ Gravel 171 Sandy Loam ElClay Loam El Clay ❑ Adobe Hardpan F-1 Previous Application Made: Yes ❑ No% Now Construction: Yes No. ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS: V1� (No septic tank or cesspool permitted if public sewer is available within 200 f�) Se tic Tank: Distance from nearest wel _<`l_Q>? --Distance from fun aticn____________________Mate`ial_______.__________._-_-_____.___�__/--_______. P a ! Li uicl de th__�_4!' -------------Capacity_$- -- + 'G No. of compartments------ - -----------------Sizes.--=__-` --- ---- q p Disposal Field: Distance from nearest well_C7". '.-Distance from foundation___--d__._______.Distan - to nearest lot line- 57 ------------ Disposal -- --- - -- nth of each line----:y�----------------Width of trench--- ----- ------------ Number of lines-------------- --- g Type of filter material-: � ------Depth of filter material___11_ ---------Total longth____C =-O--------- .11 t� 10 Of ---------- Seepage Pit: Distance to nearest well_�Lr"- --------Distanc fr m fqundation___________________ istance to nearest lot-line__ l Size: Diameter_ -----.Depth-----�----------------- Number of pits-____1______---_____Lining materiaN✓____�`_--I_ - Lining Cesspool: Distance from nearest well________________Distance from foundation_________.---------Lquid Cap gals- r ❑ Size: Diameter---------------------------_:-------Depth-------------------------------------------- q p tY Privy: Distance from nearest well-------------- ----------------------------------Distance from, nearest building-------------------------.-------------- ❑ -------------------------------------- Distance to nearest lot line---- ---------- - ------------------•-------•------------------•----- j Remodeling and/or repairing (describe)------------------------------------------------------------- I ------------ -•- ------ ---- -------- ---------- -----------------------------------------------------------•------------•----------. -•--------------------------------------•-----•------------- 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 -rmles.,and regulations of theSaJoaquin Local eal+h District. 1 (Signed)-- - , .._ l9~7? ----------------------r_-------------- e" ontrac+orj --------------------------------------------------•------ �_�._ Title d ,Ii ......---- (Plot plan, sha ' g size of lot, location of syste in rela+ion +a wells, buildings, etc., can be placed on reverse side). �_ _� FOR DEPARTMENT USE ONLY _---- •- -- - -f--- --------------- DATE------- APPLICATION ACCEPTED BY ' REVIEWED BY--------------------------------------------- --------- ----------- ---------------------- ----------------------------- DATE------------------------------------------------------------ --------------------------------------- DATE. BUILDING PERMIT ISSUED------ ------------ ------------ ------------- --------- •- Alterations and/or recommendations-------------------------- --------------------------- F. -. _____.______«_________________________________________________________________ _ _______________________________________ __________________________________ • _________________ �. ___ _______________ ___ ____.______________________________ � _________________ J FINAL INSPECTION BY:____________________ _- = Date------- 1. ? -------=-----------•--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT no West Oak Street 132 Sycamore Street 814 North "C" Street i30 South American Street Trac California 1 Stockton, California Lodi, California Manteca, California y ES-9-2M 8-51 Revised W-2100