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� �.—-- Permit No. ------- -------- (Complete - -- ,. APPLICATION FOR SANITATION PERMIT --- -- (Complete in Duplicate) Dp ate Issued 7_15, 'd ---- f Applica}lon �s hereby"rtiade to the San Joaquin Local Health District for a penrit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS �AAN, D j_OQAtTION----y L------i- � ----------------------------------------------------------- - Owners Na, ------------------------------------------ Phone - ------ -- -- ------- - ------ ----------------- Address------- .K Phone----------------------------------- Contractor's Name---:_--��------------------- - --""-- - - -- ---------- Installation will serve: . Residence A artment House Commercial Trailer Court ❑ Motel ❑ Other,❑ Number of living units: ___ .__ Number of brdrooms� _ Number of baths _ _ Lot size ___ _!g - Q 3 - �r i, i Water Supply: Public system ❑ Community system [] Private Depth to Water Table ft. � matE,k a i Character of soil #o a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam Clay E] Adobe❑ Hardpan,❑ r Previous Application Made: Yes ❑ No LY1 New Construction: Yes 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 iJ Dista �e fr m fo_ dation--- ----------.Mate i l_" ----------- ► ,ry No. of compartments -_---- -- -- --Size___x_4__K ------Liquid depth----------1---------------Capacity--.-�_ J f- Dispos Field: Distance from nearest wel�-Distance from foundation-- _ _____ Distance to nearest to line_-___:__._!____. Number of lines---------------- -•-----------`,Length of each line Width of trench .' -1---------------- Type of filter materi rQ --�- `- th of filter material_" �} -Total length_________:_h�- ___:______/____._�__L_ 1__v___.Dist�nce to nearest lot line--------------- See it: Distance to nearest well____ _______________Distance from foundion_..._ // / Number of pits---_______/.___ Lining material_�a b)_t_�`�_ i : Diameter-----!----------------Depth------ -rte---------: - ---- Cesspool: Distance from nearest well-----------------Distance from foundation---._------------- Lining material-------------------------------gals. ❑ Size: Diameter---------------- _Depth---------------------------•------------------------Liquid Capacity----------------------------g ------ ----- Privy: Distance from nearest well_ ___" ___ Distance to nearest lot line_________________ ______________ Distance from nearest" ui1 rn j s 1 Remodeling and/or repairing (describe)------------------------------------------- -------"---------------------------------------- ----------------------------------- - -------------------------------- prepared- ---- ----------------------------------------------------------:---------------------------- ------------------------------------------------- I hereby certify that I have 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,) 5ined �- �4.___tom___------ --- -- ,r ---------------- Title - ------- -------------------------------------- (Plot plan, showing size of lot, location of system in rela#ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED-BY----- -------- --- ------------- ----- - ----- DATE _ %----------------------------------------------- �. = .+.n �,.. REVIEWEDBY----------------------------------- --- -- ------- --------- --- --- ----- ------------------------------ BUILDINGPERMIT ISSUED----------------------- -------------------------------------- ---------------------- DATE Alterations and/or recommendations=------------------ --------------- -------------•------------------------------------------------------------------------------------------- ---------- ------------- -- r€�tr fI r � > dcr E' I� � � - ----- -- ------ ----- - ------------- - i I ' FINALINSPECTION BY---- ---------------- ------------ Date -------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100