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APPLICATION FOR SANITATION PERMIT Permit - 3 (Complete in Duplicate) Date Issued T plica4-ion is hereby made to the San Joaquin Local Healt District for a permit to con uct and install-the work herein described. This application is made in compliance with County ante No. 549. JOB ADDRESS LOCATION. .oe �� v Owners Name---- ------------------------------- -- r -------- --------------------------- - lwxl 7 Address--------------•---- ® b* . Phone Q ---------------------- ---------•- Contractor's Name-------------_-Q - � � �j � ! Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ----I.- Number of bedrooms -- '-- / ❑ `Yhlumber of baths .---- Lot size ----.-� - Water Supply: Public system Ej<communify system ❑ Private ❑ Depth to Water Table _"soft, Character of soil to,a depth of 3 feet: Sand [;(Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ I No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p is T nk:.. Distance from nearest well------ ----------Distance from foundation----------------- Material ------------ Dis of compartments--,w -Size--------------------------------Liquid depth------------- ---------- Capacity------------------ -- { D al F'el Distance from nearest well-----------------Distance from foundation-----------._----.-.Distance to riearest'lot line------.__---.---. y Number of lines-----------------------------------Length of each line------- .-----Width of trench.--------------- Type of filter material----------------- YP Depth of filter material------------------- ---Total length---------------------------------------.-- Seepage Pit: Distance to nearest well_-t(07?92J__Distance from foundation--_ Q,�__-__ , ------ Distance to nearest lot line- ___-__ ®-___ Number ofits.. -Size: Diameter-_ �� P �--�-�----�- ---Lining material- - - .-- �. ---- ---Depth--- of I----------- ------ Cesspool: Distance from nearest well----------------- from foundation----------------....Lining material _---------..--_--------------- ----- L] Size: Diameter == Depth -------------------------------Liquid Capacity-------------------------- -gals. Privy:. Distance from nearest well------------------------------------------------- Distance from nearest building Distance to nearest lot line---------------_- --------- ---------- Remodeling and/or repairing (describe):_------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ----------------------- ---------------------------•- ----.----- ------ ------------------- --_----•_----------•-____••---------•----------------------------------------------------•_•--••----_...----•-_--_•---------•-------•-------------------------------------------- .----- hereby certify +ha have pr red this application and that the ork will be done in accordance with San Joaquin County ordin es, tate laws, an rules a d, egulatio f the San Joaquin L cal Health District. a (Signed)--------- --- --------- ------------------------------------------- --- BY: ---•--- ----------_---------- � rContractor) {Plot plan, showings a of lot, location of sys+ relation to wells, ridings, etc., can be pl�c_ed on reverse side). i t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---.........'\__1 ----- ------- --- --------------------•---- ------ DA - REVIEWED BY _ .. ---- --- ............................. - -- DATE---- - --- BUILDING PERMIT ISSUED---••------------- - - ----------------•----------•----------- ---- ---------------------------------------------------- DATE ` ---------•--------------------- Altera+ions and/or recommendstions------ - ---------- _------------------------- ------------------ ----------------------------------------------- ---------------- ------.-- ----------•-- ---------------- ----------------------------------------------------- '_ ,�.. _ -- ------------------ FINAL INSPECTION BY:-__ __-_-...- -- Drs .� r Date. ---- ---------- !`<< SAN JOAQUIN LOCAL HEALTH DISTRICT 130'Souih American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California . t Lodi, California Manteca, California Crecy, California ES—s--2M 1n9446 Arw000 12-54 .6