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301S '! APPLICATION FOR SANITATION PERMIT Permit No. _____ ,, �1 (Complete in Duplicate) gio ,b., Date Issued .-- �--�•-• 7-. pplication�is hereby made to the San Joaquin Local Health-District for a permit to construct and install the work herein described. Sis. application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA IO ,J ----- �- ------ --- -- ---------- -------_----------------------------------------------------- ---- -------------- Owner's Nam .' �� Y � � ' Phone - 4- Owner's x ri ------------------ ---•-•---------- ------------------ Confractor's Name-------- c= Phone ' -+ � Installation will serve: Residence Apart- nt House.E] E] T Commercial railer El Motel Other Number of living units: --- Number of bedrooms _33___ Number of baths -[___ Lot size ----------------------- Water ___________.__.__._-_Water Supply: Public system Community system ElPrivate ❑ Depth to Water Tablelft. E e Character of soil to a depth of 3 fee+: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan E] Previous Made: Yes E] No9 New Construction: Yes No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank, Distance from nearest well________-_______Distance from foundation--------------------Material_____.______._____________________.____-_-____. No. of compartments--------------------------size------------------------------"Liquid depth- ------- ------ --------Capacity----------------------- V Disai'FieJ Distance from nearest well------ Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each'line------------------------------Width of trench-------------------------------_--- K f Type of filter material_________________________Depth of filter material-----------------------Total length------------------------------.----------- ;e/s epa a Pit: Distance to nearest well_ . --'_-__ ' Distance from Dundation__ � _/ D e---____.Distance to nearest lot line__--_ �.�-._ Number of pits#-------��.-.------Lining materiaI.�-:-. - ------Size: Diameter----_ ��P--------- epth---- ----------------- spool: 'Distance from nearest'well_ -----------------Distance from foundation'----------------- Lining material____.________.____________.___-__-- �� ❑ i Size: Diameter-------- ----- } -----Depth-------------------••-------- -----•----_=----------Liquid Capacity------------------ - ----gals. Privy: Distance from nearest well-------------------------_---------------------__Distance from nearesr building______.___.__.___.____________..__.__..._ ❑ I Distance to nearest lot line--------------------------------------------------- Remodeling' hd/or cepa'ring {des' e): x - l ._ 7r err- -------- 1 � - -- -- -- ---- ---_-- C = �- - --------------------------------------------------------------------------------------------------------------- --- ---------------------------------; --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I h reby certify th I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and requotions of the San Joaquin Local Health District. �/[�' �-�-�` -- (Signed) Zwnnd or Contractor Y / ) gY: r - Title= � -- ----- ( �� (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be ple6ed on re). 6 FOR DEPARTMENT USE"ONLY REVIEWED 13Y--------------------------------------------------------- ------`--------------------------------- DATE= APPLICATION ACCEPTED BY------------------------------ --- ---- -- ` DATE---------------------------- �-BUILDING PERMIT ISSUED------------- -------------------- ----------- --------------------------------------------- DATE -------T___7----------------------------b----------- Alterations and/or recommendation``s:---------------- --------- --------------------------- -----------------------------------....-----------._.._. .----•----- ------. --------------- lit " " . 1 1 .�� ?; ----_--4t__lV ��f. 1' _ x` � i. - ------------------------------------------------------------- FINAL INSPECTION BY-------------- a_24U) -------------- Date-------------C� -------------------------------- (SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California a` ES-9- 2M 10-52 Revised W-1100 d