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y APPLICATION FOR SANITATION PERMIT Permit No. ._ �__ _.___ (Complete in Duplicate) ^CJ 30 S�- Date Issued ______. _.-_. App ication 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--- -------='�-4----------� TL ---------------------- Owner's Name----------------------------------- ' � ------A,-•----------Z_A_Z1'Z--------------------------------------- Phone-----------------------------------S - Address -- -� -----------4--------------- --------•---•----•-•-----------....-----•----••--•-----•---------_----------•----------•---p----------------. Contractor's Name------------------------------—BBm_gt;:�_ !�47------------------------------------------------------- Phone --9=5 ; --- hone .--9 574; ---- Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1__ Number of bedrooms .y Number of baths --_ Lot size _ 10-a-`X 3-^0 Water Supply: Public}system El- Community system ❑ Private ❑ Depth to'Water Table.________ ft: Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe_ +K Hardpan ❑ Previous Application Made: Yes ❑ No -=N w Construction: Yes, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS`` " (No septic tank,'or cesspool permitted if.public sewer is available within 200 fe't.) Septic Tank: Distance from nearest well-�©______Distance from foundation_ ___________..Material__-.____ --- 4K No. of compartments__::._-_-Y--_-____.Size_//Q�"�- -_ .......Liquid depth_._-_i�g'*l_-_---___Capacity_, f^ -- Disposal Field: Distance from nearest well�l--la_.__._Distance from fours"dation_--�D-'-- Distance to nearest lot line--------- � Number of lines_. f----_"� + --- -�=-----Length of each line----� �-'---------Width of trench---- .`t�`�----------------- Type or filter material_ -±�- Depth of filter material________�.11---__Total length----Z 0S -- __ _ ___ _________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- to nearest lot line__.-_-__-_._.._.. ❑ Number of pits-At---- -----------Lining material--------._--.----------Size: Diameter-----------------------Depth---------.:-----_---------------- v, I "i - Cesspool: Distance from nearest well______________-_Distance from`foundation-------------------.Lining material--------- ------____.-_.____________- ❑ Size: Diameter-------------------------------- 7-Depth--------m._5----------------------------- ------Liquid Capacity----------------------------gals . , Privy: Distance from nearest well------- -------------------- ---------Distance from nearest building--------------------------------------- - ❑ Dis#ance to nearest lot line------------------ - - Remod linIq and/or repairing ( scribe):----_------------ -_ ! --- - - ---- -- c-`��----- --`---_----_--- = ---- --------- --- --_----------------------------- ----- -------- ------ --------------------------------------------------------- _47 ------•.•------------------------------------ a l hereby ce ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and recd lations of the San Joaquin Local Health District. (Signed)--------------.-- --- -�s-n'c,------------------------- Contractor) V 1h sY ------------ � ;` ----------------, - - - - ------------ {Ti+I ] _. 4 ' (Plot plan, show size of lot, locat on o system in relation to wells, buildings, etc., can b edlon reverse side). + I FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_ _"'"___ --__----- DATE__ + BUILDING PERMIT ISSUED---------`� ,'` - DATE-E - Alterations and/or recommendations:-------------------------- ------ - ------------------------------------------------------•------•-------------------- --------------- -----•-------•------------------------------------------------ ----------------------------------------•-•....... -------------------••----------------------•---------•------------------------- l ------------------------------------------------------------------------.--------�- ------------------------- -----------------• -----------------------.....------------------•----------------------------------------------- ---------------------------•------•----------------•---•---•-••----------- -------------------------------------- ------------------------ ------ _ II i FINAL INSPECTION BY:. Date-------._.II- 7 SAN JOAQUIN LOCAL HEALTH,DISTRICT 130 South American Street 300 West Oal Street 132 Sycamore Street 814 North "C" Vreef, Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M M-52 Revised W-2100