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17 APPLICATION FOR SANITATION PERMIT __ __• Permit No. ___7 ________ 7- (Complete in Duplicate) J 3l �- Date Issued ___ � 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_._,3_7_ Z'----- R__E d '�T ---------------------------------- Owner's Name. L ------------------ Phone..-- --4--•------- '� / Address Q /1�u:.-. Contractor's Name----- C--`----------- ----- - ---------------------------•-------------------------- --------- PhoneA _L.l_4_14_7------ f�SPR�-^S-N----�-�--^-�- . _. Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel I—] Other ❑ Number of living units: __l____ Number of bedrooms„ --_ Number of baths ..f_._ Lot size __-_:_7.. __ ___I_u-- --------------------- Water Supply: Public system ❑ Community system ❑ Private 2 —Depth to Water Table XY ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [E Hardpan ❑ Previous Application Made: Yes ❑ No [fl-- New Construction-. Yes ❑ No Efl--' TYPE OF INSTALLATION AND SPECIFICATIONS: le (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------------Distance from foundation-_----------------.Material________----.__.__-____________-------.._____- ❑ Na of compartments------------------ -----Size----------------- -------------Liquid de th----------- --- - ------Capacity----------------------- Disposal ---------------------Disposal Field: Distance from nearest well____-------------Distance from foundation--------------------Distance to nearest lot line________._______ ❑ Number oz' lines------------- --------------- ----Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material---------------------Total length------------------------------------------ .0 '_____.Distance to nearest lot line__. J__ ____ Seepage Pit: Distance to nearest well .O.C►_�_._.___Distance from foundation___ (,J - Number of pits- -------�----------Lining material-------A;i;_Size: Diameter---------------Depth-----�.J--------------------- Cesspool: Distance from nearest well-----------______Distance from foundation---.--------------- Lining material___.____._..____._.-----_____._____-. v ❑ Size: Diameter--------- ----------------------------Depth--------------------------------- ------------------Liquid Capacity----------------------------g.Is . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________________________ ❑ Distance to nearest lot line............... ------- ---- y/� �� -,� -- --------------- Remodeling nd/or repairing (describe):------/.>._-G--G_/_�l_D.-N�--�"--.•--��/-J"-��--�-----------�----••-•--------- I�-------- - . _�.�...�_40-01-Z. _ -------------------------------• ----------------------- ----------------------------------------------------------------------- I hereby certify that I have p pared this application and.thaf the work will be done in accordance with San Joaquin County ordinances, St aws, and rule d regulations of the San,Joaquin Local Healt istrict. 0.1---- -- ----- -_t (Owner and/or Contractor) By:--------------------------- ---------------• ------------- --------------------------------------- ----------- --- -- ------------------- --------------4� -0 4 (Title)_ aS-T (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- -- ---------- ------ DATE-------------•Z--------------- ------------------------- REVIEWEDBY---------------------------------------- --- --- ------ ------`'--------------- ---------------------------- ------ DATE------------ -------- BUILDINGPERMIT ISSUED-------_-------- ---------------- --------- --------------------------- DATE.------------------ ` Alterations and/or recommendations:----------_--------- 9-----------------•-•- ------- ------•-------- - ------------ --- ---- - ---- �-� -----••--•------- �l - ----- ------------------- ------------------- --------------- •-•---------------------------------- -----------------I ------•--------------------------•-----------•-------- FINAL INSPECTION BY:------ --- flate. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Scufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5---9-2M 145446 ATWOOO 12-54