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er APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ((( eAkation bate Issued 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. JOBADDRESS AND LOCATION.. -N-------- wmjw----------------- •--------------------- -----------•---------------------------------------------- NOwner's Name------------- ------ Phone---- ----------- ------------•-•- Address. G� f ------------------------------------------- I Contractor's Name--"- ---------------•----------"-----••-"-----------------------------"---------------------------------------------------------------------- Phone------------------------------------ Installation will serve: Residence jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ---9-. Number of laths .---1!--- Lot size ------- Q-_,Y"-&0--------------------------- Water Supply: Publicsystem [X Community system ❑ Private ❑ Depth to Water Table -. --- ft- Character of soil to a depth of 3 feet: Sand ❑ rGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: .Y.es I]----No M—New Construction-,-Ye 5 —No°❑`"` "' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 ° I SGS Septic Tank: Distance from nearest well_.___N-------Distance from foundation_-- t � � � �� -�-------- -- Material------------�--- ---------------�-- No.,of compartments-----------�-----.-----Size-.."-_.T-YCX-3-------Lgqiquid h--.- 4' ---------- pE9 C fp i h----------- line------ --------Q Disposal Field: Number lines earest well ",ji Length of each line----',`"" "" G """""" V��dthDistancofttre crest to �� ----------- i Type of filter material-------- - ----- ---Depth of filter mater�aL:------- ---"----.-Total length------------ -?C------------------•-----� Seepa Pit: Distance to nearest well---------------- Distance from foundation-------------------.Distance to nearest lot • Lining - Depth - s --Cesspool [Dstance from nearest well ---- Distance from foundation-----"--------------Lining material------------------------------------- El ----------- --_-❑ Size: Diameter-------------------------------------Depth_---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distarfce'from.n..earest well-------------------------------------------------Distance from nearest building------------- -----------. ❑ 6isfance to nearest lot#ine- y Remodeling and/or repairing {describe) 7 -- -----="------------•-------------------------------------------"-- •------------------------ ----------------------------------------------------------------------------------------------- •---------------------------------------------------------- -- --------------------------------•------------------•----�;- -------------------------- -----------------"-------------,...------------------------------ ------- 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, rules and regulations of the San Joaquin Local Health District: V1111f �- M (Signed)-----------------15 ------ ,y } ---------------------- ------------- {Owner and/or Contractor) 3 Plot Ian: showing size - ------ {Title) ' BY� g P ) ( p g of lot, la ation of system in relation to wells, buildings, etc., can bei laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- I----- --------- _ DATE------------. ----- -DA I ---------------------�-�-�-------------- } Y - = REVIEWEDBY------------------------- ------------------I----- - =----------------- BUILDING PERMIT ISSUED--------------------- -- - - - ------ DATE--------------------------------------- Alterationsand/or recommendations--------------- ----------------------------------------------------•--------------------------------------------------------------------------------------- --------------------------------- --------------••------------------------------------ ------------------------------------------------------------------------------------------ ------------------------------•-•-•--------------------------------------- •----•-------------- -----•-------- 1-------- ------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- t ------------------------------------------------------------------------- ------------------------•------------------------------ 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 k s ES-9-2M +0-52 Revised W-2100