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„, APPLICATION FOR SANITATION 17 PERMIT Permit No. ._ 6.. (Complete in Duplicate) 7 U' ti' Date Issued ----- _____.- � ,\h �\�Applicati.on 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. � 1 JOB ADDRESS AND LOCATION----,of- -./-07-. --,�i9, l a—tO12-- Q_ o � �`, ---------------------- F�1!'7 ----- !?I _ 5------- ----------------- Phone -r--------- Owner's Name-------------------- -- -----••-------- ----------------------- Address---------- J. 7 7-26-mm-7- -_ - -------------------------------------------------•--------- ` , Contractor's Name----------------•---- fifl-.4� ��J�S� -- Phone Installation will serve: Residence 1' Apartment House ❑ Commercial ❑ Trailer Court ❑ el [ Of er ❑. N umber of livingunits: _1___ Number of bedrooms +�__ Number of baths ___l_ Lot size _-- =-_ -------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Tabl ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Cla oam El Clay ❑ AdobeHardpan ❑ Previous Application Made: Yes [-] No ❑ New Construction: Yes E] No �ft< ~ TYPE OF INSTALLATION AND SPECIFICATIONS: W.- ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic,Ta�� Distance from nearest well_______________Distance from foundation--------------------Material_________-_______-_____---_--------------------'� ”' Liquid depth Capacity A No. of compartments --------- Size q p p tY -- ii++" y" /� i f s isposal Field: Distance from nearest w __.Distance from foundation_ _________________Distance to nearest lot line__________ rr Number of lines-------- �__js____ --Length of each lines_ �1 ________.Width of trench_- �jL__________________ of_____Total len th r Type of filter material---I - '--- ---Depth of filter material------_� ----- g --- ---•- t � r Seepa e Pit: Distance to nearest well xwo�_-____-Disfancef Rrr� f undation__�QQ______-.Distan##f to nearest lg�t {ine____ __________ xNumber of pits------/--------------Lining material---"--- -----Size: Diameter----v.-6.3------ Distance from nearest well_________________Distance from oundation_-__________----___.Lining material___________.____________----..._____- ' ❑ Size: Diameter--------------------------------------Depth---------- -----------------------------------------Liquid Capacity gals. Distance from nearest buildin Distance from nearest well----------------------------------------- g ---- Privy: ❑ Distance to nearest lot line________________________ - - ------------------------------------------------------------------------------------------------------------------- Remode4ing and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- I hereby certify that 1 ave pr pared this pli ation and that the work will be done in accordance with San Joaquin County, ordinances, Sta la s, and rules d reg lation of-the San Local Health District. (Signed) t - ----�` R ��------ �---re-------------------------- > � Contractor) {{ �7i- _� $y--- ---------- - - - -----------c-.9----- ---- --- ----- ---------------------------------------------------------(Title} ' (Plot plan, s owing s ot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR ARTMENT USk ONLY APP,LICATiON ACCEPTED BY + -------------- DATE + � REVIEWEDBY-------------------------- --------------------------------------------------------------------------------- DATE----------- ---------.......----------------------- BUILDINGPERMIT ISSUED--•--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsarld/or recommendations----------------------------------------------------------------- -----------•-------------•---•--------------------------------------------------- --------•-- ----------------------------------------------------------------------------------------------------------•-------------------------------•---------------------------I--------------•-- y ------- ----- - ------------------- --------•-------------- ----------------------------- -------------------------------------- 1 � / FINAL INSPECTION BY--------------- - --- -------------- Date---------� J -G------- ------------------ 7 SAN JOAQUIN LOCAL HEALTH DISTRICT t b I 130 South America,{Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California 8-51 Revised W-2100