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APPLICATION FOR SANITATION PERMIT Permit No. __ -7 �__-• [Complete in Duplicate) 7 Date Issued ______l 0& • 'L2.�._,mac, -r�3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d bed. This application is made in compliance with County Ordinance No. 549. .�— JOB ADDRESS AND LOCA TION -. - . --=r____�'� Owners Name---- -- -�---- c4ri�. r—--------f--------------�------z- Address. c ., . g °'. . - --------------- ------------------ --------------. ------ -- ^� Contractor's Name----- Installation . Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ 4 Number of living units: _- ____ Number of bedrooms .:.?_—_-Number of baths .__/L-- Lot size ___ ------ _________________ Water Supply: Public system ❑ Community system ❑ Private W_ Depth to Water Table 14!!!� ft. I Character of soil to a depth of 3 feet: Sand a Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ZI New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well_,g5rV.-------Distance from,�fo�n`dation---fQ__-.-------M teri-al___��-------__-----_---_ __________. No. of compartments-----�-------------Size--. f`�ac- ----Liquid d�pth----�tf�-------------Capacity---- Lf -- - Disposal Field: Distance from nearest well---&B_`....Distance from foundation_--/4__.__..___.Distance to nearest to line.-d Number of lines----------- -- ------------Length of each line--------/"- f„ --.-.Width of french------ Type of filter material_ ..._ _ e__Depth of filter material-__./_'9----------- length-----/"”`�_________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______________ El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------.- Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material-------------------------------------- 1-1 Size: Diameter------- --------- --------------------Depth---------------------------------------•-----------Liquid Capacity---------------------------gals Privy: Distance from nearest well-___....._______...-- ------Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line-------------------------- ------------------------------------•---------------------------------------•------------•---------------------- '.� ^•c - Remodeling and/or repairing (describe):____�G�---.--;/,�,kLG'4��------••�--�`-�-----u-- ''- ---------� ------------- -----------------------------------------•--•------•------••------------------------------------•----------• ------ -----------------------------•--------------------------------------- ILI - -------------------•---------- ------------------------------------------------------_-•------------------ -----------------------------------------------------------------------------•------------•----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coty ordinances, State laws, and ruleZan egulations of the San Joaquin Local Health District. (Signed] -------`-$= - ------ -----------------------------------(0 ner and/or Contractor) ay:--- ? 'L�s'u. -� --- G�--------------------Title) -------s----------------------------------- (Plot plan, s owing size of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ---c_ DATE-------- j REVIEWED BY----------------------------------------------------------- ��------ ------ ----------------------•-------- DATE--------- ---------- ------------ BUILDINGPERMIT ISSUED------------------------------------- ------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------- ----------------------------------••-------------------------•-----------•----•--------------------•---•---•--_-------------•-•-•----._.. ------------------------ ---- ..--------- - -------------- --------------------------- / ,- FINAt INSPECTION 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 E5-9^ 21,4 145445 AT-COD 12-54