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APPLICATION FOR SANITATION PERMIT Permit No,e 1.-_�-_4_••-G_ (Complete in Duplicate) ' Date Issue �Z �� ' - - Applica+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 Ordinance No. 549. . JOB ADDRESS AND LOCATION-------------South -'�as,t_-corner Davis & Woodhridge�R Owner's Nameg --- �7-�-----�-- -�---�---�--- �r ---•---•---------------- --..- - Phone 9rg2[ Address. Rt2Box 372s --moi, Calif.- -------------------------------------- Contractor's ---------------------•----- on ractor s Name------- Same , --------------=------------------------•-------•--------------- -------•---------- Installation wills Phone-----------------------serve- Residence - -------•- [2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___y-- Number of bedrooms 2'--- Number of baths --L--_ Lot size ------_1.,{j Water Supply: Public s stem t �7 •--------•---------- pp Y� # y ❑ Community system ❑ Private Q Depth to Water Table -----__ ft. Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E Previous Application Made: Yes ❑ Nog] New Construction- Yes [2 No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or c pool permitted if public sewer is available within 200 feet.) r } Septic nk: !Distance from nearest well----50_-----Distance from foundation---.-22_ � iJo. of compartments__ *_ :----.Material-_---_ a??Crete ,+ , 4 P Size 3X3---------------------Liquid depth---- 4ft-------------Ca Capacity--, p tY----- Disposal field: Distance from nearest well 3X3 from foundation.-----,25- F_-_-- Number of lines--;-.._--___--�-_- Distance to nearest lot line 20 of each line0--------_ .Width of trench. 2. ft. Type of filter material-__dock -----_ Depth th of filter material-_1$---to.-_2-VTotal length-----------=_ft..-------•--- Seepage Pit: Distance to nearest well.- .._--__-. ---Distance from foundation-------------------- � Distance to nearest lot line----------------- ❑ Humber of pits.-.------------------Lining material------------ - Size: Diameter---------- Cesspool: Distance from nearest well •-----------Distance from foundation -----}- - g material -... � ..❑ Size:-.Diane#er;-_ ---=--- _,__�_ -Depth_-.--.�_•,,.�..rt,...� -------------------------- Liquid •---- _= Capacity gals. Priv ----------------------- --_--___D.is#ante from nearest building--_---__--_-----__ ❑ Distance to nearest lot line-------------------------------- ------�.. ---:------•--------.. Y istance from nearest well------ _.------__ ------------------------------ ---------------------------------------- ---------- Remodeling F , --------------- "-.- ------- - r* - Remodeling and/or repairing (describb):--------. .__--`_- ---------------------- -------------- ------------------ ' -------- ---------------------------- ------------------------ ---------- ---------------------------------------------------•---•--------------------------------- ----------- 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, and rules and regulation's of t�n Joaquin Local Health District. (Signed) _ -- — a :- - .._--- - ----------------------------- -----rOwner and/or Contractor) By• _ __ ------------------------ -- - - (Title) - - (Plot plan, showing six -e'of lot,64ocafion of system in relation to wells, buildings, etc., can be placed on reverse side}. I FOR -DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y------- ---------- -- ---------- DATE------- y S- ----------- `� ------ DATE---- UILDING PERMIT ISSUED- - ----------------------------=--------------- ----- ----- DATE------------- Alterations and/or recommendations:_,_----._-..'..- ----------- - -------------- ------,-------.----- ---------------------------------------------- t ---- -----------------•--------•-••-•------ ----------------------- - FINAL INSPECTION BY: = -------------------- Date-------- Date-------- ate!_ _f LOCAL HEALTH DISTRICT -_ 130 South American Street ! 300 Wesf'Oak Street 132 Sycamore Street Stockton, California 814 North "G" Street Lodi, California Manteca, California t Tracy, California —9-2M Revised W-2100 1