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} s, APPLICATION FOR SANITATION PERMIT Permit No, -. k f r { (Complete in Duplicate) � Date Issued �:�_---.� Application is hereNyvma 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 Ordinan e No. 549- JOB ADDRESS AND LOCATION_--_ �e -_ , --------------------------------------------•--- Owner's Names /?'IQ t1*' -------------------------------- --•-- Address-----------•----•----------------- 1`3 0 _.--.�,�" ----------------------------- -• ------ -- Contractor's Name-------------•--•------------- ---- ------------------------------------------------ Phone----- 'y� Installation will serve: Residence If Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms __' Number of baths _-Y Lot size _-- ,SS- _--------(S—C) — ____----___ °Water Supply: Public system �,` Community system ❑ Private [2 Depth to Water.Table ft. Character of sail to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe�[ Hardpan E]Previous Application Made: Yes ❑ No 1% New Construction: Yes JC No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well - ��_Distance from foundation--��_r-_--------Material--- __ _----__ Ix - Size_ ��--_�.*A Liquid No. of compartments 43� , q d depthZ�! Capacity - � Disposal Field: Distance from nearest well_1�QNE_Distance from fo dation__1_S7_f_ - ' _ -----Distance to nearest lot line--_,<..y- ----- Number of lines_-1---_------ Length of each hne_0:,2Tr�`4-Width of tren h_�- _-.---. Type of filter material-+- -- Depth of filter material-- !._____-.Total length- --__'------------- See e -----__-Seepage Pit: Distance to nearest well_AGAE---------Distancee,�fwm foundation-1-s7-..-----. fDistance to nearest lot line----jQ_�- YA►* Number of pits----J-----------------Lining material-Im-V)___----Size: Diameter_-.3 �--------Depth_-.z. 7 Cesspool: Distance from nearest well-------------_--Distance from foundation--------------------Lining material_ _-_--'-_--_ ___ F-1 Size: Diameter-----------•-------------- -----------Depth----------:------------•----------------------------Liquid CapacitY-----------------___---------_-_-----------ga_-1_S_ s. Privy: Distance from nearest well---------------------------------------------------Distance from nearest building ❑ Distance to•nearest lot line-------------------- - ------------------------ Remodeling,and/or repairing (describe):..-------------------------------------------------------- ----- --------------------------------------------------------------------------------------------------------------•--------------------•- ----------------------------------------------------------------------------- I hereby er y that I have repared is application and that the work will b done in accordance with San Joaquin County ordinances, St to ws, and rule nd re tions of the Joaquin Local Heal District. ---- --- - -- (Signed) �� I ---- --- ---�-------- ------------------------ ------------- Contractor) By:-------------------------------------------------------------- ---- k'=---- - TitlePac:ed -----(of p an, showing size of lot, location of syste in rela ' n to wells, buildings, etc., can be on reverse side). FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY-------- -------------------------------------------------------------------- -- .DATE_ REVIEWEDBY--------------------- ---- -- ---- ----------------------------------------- ------------------------------------------ DATE- BUILDING PERMIT ISSUED DATE �s Alterations and/or recommendations:---------__-__--------------------------- ----------------------------------------- ------------------------------------------------------ ------------------------------•-------------------------------- ------ -----------------------•--•----------------------------------------• ------ FINAL INSPECTION BY-----------------------6a- ��/// -------- ------------------ Date------""!-' -------. --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f ES-9—,�,2M 10.52 Revised W-2100