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sN APPLICATION FOR SANITATION PERMIT Permit No. 7 (Complete in Duplicate) Date Issued 4Applica+ion 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 Ord/in�ace No. 549. AND CATI N---- O 4.x,1- --�.Y?l _J > f --------�wQ 1 �. JOB ADDRESS '1 --- � - �( - ------ Phone--------'r--------------------- Owner s Name-----_---- Address--- ___________Address--------------------------- ` `--- { `�----- - - Phone Contractor's Namefjw �! 'ZC ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number o- baths .__— Lot size __. _nl�rte_t_j--"P----------------------•- Number of living units: .__.!__ Number of bedrooms _� � TM Water Supply: Publics stem ❑ Community system ❑ Private umber to Water Table__ ft. Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �w Construction: Yes �10 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) r ---------------- Septic nk: Distance from nearest well-4 ��m foundation--.. Q_ .._ Material._.__ _ __________ No. of com artments_ Size__ Liquid de th__ ______________Capauty___p_� p . ,' �? - - q p. - - ------ w 0 sZ ` - s Disposal field: Distance from nearest well_�Q..__-_.Distance from fours ation____ __ __ _____Distance to nearest lot line-------- _...... I Length of each line___- --� �Nidth of trench-___.�V�r_______________ Number of lines______ _______ _ 9 ''�""�- „ 1 y -y! ss� pp Type of filter material__�__ _______._S---Depth of filter materiaL___ 4...._____.Total length____ i ________________________ Seepa Pit: Distance to nearest well_�.Q.Q__�_._ Distance foundation---149-`�.__..Distan e f nearest lot line_`_____ e Number of pits.--/------------ - ---Lining material-12,'1� -----Size: Diameter--_ ---------Depth--..c --,Cr --------------- Cesspool: Distance from nearest wel4-----------------Distance from foundation------------________Lining material----_____ . Size: Diameter------- ------------- ------------ p --------------------------- ElDe th----------------------------- -------------- - -----Liquid Capacity---------------------------gals. Privy: Distance from nearest vrell-------------------------------- --Distance from nearest building----------------------------------------- El ------------------------------- Q Distance to nearest of fine-----------------------------•------------------- -------------------------------------------------------- ---- --------•- --------------•---------------------------------------- Remodeling and/or repairing (describe------ ------------------ --------- ------------------------------------------- - --------------------------------------- -----------------------------------------------------------------------------•--------------- - --- - --------------------- ---------------------------- ------------- ---------------- ----------- I hereby rtif that I ve prep ed is appiicaTn andthat the work will be done in accordance with San Joaquin County ordinances, 5t aws, and ales and egu ations of tan Joaquin Local Health District. ontractor) _�._1__� - - ----�------- -- =n -------------------- (Signed)_._. s --- 7can -- (Ti+lel Y• . -- be lade' d on reverse side. [Piot plan, showing size of lot, location of system m relation t we11s, buildngs, p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- ----------- DATE ,�c `S------------ REVIEWED BY------- --------- -------------- ------------- ---------- -- ------------- DATE---- BUILDING PERMIT ISSUED-------------------------------- _ DATE-------- --------- -- ----------------_------ REVIEWED BY and/or recommendations:----------------------- -- -- X11 ---------------- ----------------------- ------------ ------------ ----- ----------------------------------- FINAL INSPECTION BY:---- � .-`---�---- Date--- --^-- ----------- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 A7W01D 12-54 r