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- 1� APPLICATION FOR SANITATION PERMIT Permit No. _.._1.. _ (Complete in Duplicate) Date Issued Application 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. Z,3 JOB ,ADDRESS AN LOCATIONJ-`1-- -- N� x, �r G Owner's Name ------•-- --Ck.��-�---•��:--1.----- --_�`---�-- --5- - - - 1 r� ------- ---- ---------------------------- ------ -------- Phone_ Address--------------- -1.1_4- ----•---- '7 -------- Contractor's Name ----- 3�1---------;- �----------- Pho: � Installation will serve: Residenc.rA'partment House [] Commercial ❑Number of baths Trailer_ curt _ - ourt E] Motel ❑ Other ❑ Number of living units: _.'~'_ Number of bedrooms "` '��_ Lot 0size . .W rr,.._ .. Water Supply: Public system . Communit system Y stem ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No D-�New Construction: Yes ©—No ❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if p blit sewer is available within 200 feet. Septic Tank: Distance from nearest well_ -Q�Disfiance fpm foun a ion__ \R / /�-r...Material.__. y No. of compartments (c ----- ---Size_ --------Liquid dept`---�T«--------Capacity' (� Disposal Field: Distance from Haar st weli. ��----"--- �.-- 4t---.Distance from foundatio ---------- ---------Distance to nearest lot line_.--es .6 °F Number of lines----- ----- -------------- Length of each line----- Q 0� T e of filter material-- Type Width of trench-_,..- -- --__ Yp Depth of filter material..-_-/_c '..Total length g �-C---------- ---------- Seepage Pit: Distance to nearest well----- ----------------Distance from foundation__-__._._..._._.....Distance to nearest lot line__._.._..____-._ ❑ Number of Pits.---------------------Lining -------material----------------------- -------- ------Size: Diameter...---.-. _ - ------ ----.Depth-------------------------------- Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Lining material..-..--..-_-.-_,..__ _ El Size: Diameter----------------------- -----------Depth--------------------------------------- - ------- Liquid CapacitY----------------------------gals. Privy: Distance from nearest welf--..__-._-------------- --.-------__ --Distance from nearest buildin ❑ Distance to neares line g Remodeling and/or repairing (describe):-_ ------- lac ` ------•----------------------•---------•-----•------------------------ ------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Streaws, and rules and regulations of the San Joaquin Local Health District. Si( finedtJN1._S,.h---�'-� ------..��----�- ---- _ - ------- ---- - - ----------------------------- By:• -------------------------------------------------------- Title Contractor) ---------,J-- -- ----- - -- -------- -c---_-- (Plot plan, showing size of lot, location of system in relati o wells, buildings,s c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ __ i ----- -- ---------------------------------------------------------------- REVIEWE_D BY------ ATE.. - ------ DATE - - ------------------------------------------------------- BUILDING PERMIT ISSUED _;i, ------------------------------- ----- -- --------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- -------------------------------------------------------------------------- FfNAL INSPECTION BY / t��/------------------- Date 1LL_ _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-21d , Revised 1-57 F.P.[o.