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r f*;Il PPLICATION FOR SANITATION PERMIT Permit No. .- f-3- l D i l (Compete n upice}e) ! .Z Date issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe d. This application is made in co pliance with County Ordinance No. 549 ��© � t l --- YI .Y1. , JOB ADDRESS ANS tOC TION____________ _ Owner' a----• -•• ��c�T��".��.---•---•--�-`---��---�: ,-- - t- -------- ------- -------------------------------- Phone r 11 - i --------- Address-- ©:_ _C? �N_�._le-A-t /�' -- ----- �s C Contractor's Name-------•------------------------ - ----•�-•------- -------•--- --------------------•---------- ------ •---- Phone. - ... 40. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ �otel ❑ Ot er ❑ r of living units: -------- Number of bedrooms ________ Number of aths ____--- Lot size iF:—.._---�---------- ------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table t. Character of soil to a depth of 3 feet: S;�kNew Gravel ❑ Sandy Loam El Clay Loam E] Clay ❑ Adobe Hardpan E]Previous Application Made: Yes El No Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) ° A`T,. Distance from nearest well__.___________--Distance from foundation__________________Material____________._._---_--.________-__..______----- NC w o. of compartments----- ---- ---------------Size----------------------------•---Liquid depth-------------------------Capacity----------------------- o ietd: Distance from nearest well_________________Distance from foundation-------------------.Distance to nearest lot line_-.-._________-- ,wrNumber of lines-----------------------------------Length of each line------ _-__------------- ----- .Width of french.----:----------------------------- ��"��" Type of filter material-______________ ______ Depth of filter material____...___.___ __._Total length___._____.___.-.________._________.. 401 Seepage{ ' : Distance to Weare twell-_ __ - Distant rom undation___.____ _QDi ant%to nearest 1 me__ __L.l_ 00 Number of pits.._1�_________________Lining material_ Size: Diameter_ .____.Depth._ , - ----------- Cesspool: Distance from nearest well-_______________ Distance from foundation- ----------- material-----------------------_- _ ___._. ❑ I Size: Diameter-------------- ------ - --- ---------Depth----------------------------- -------------------..Liquid Capacity-----------•-------- 9415. Priv Distance from nearest well-...-_.__--------------------------------------Distance from nearest building----------------------.-_-______--_------. ) Y' �i r ❑ Distance to nearest lot lire------- ------------- ------------------------------------------------------------------------------ Remodeling -------------------------- Remodeling and/or repairing Idescribe):------------------------------- - •----•----•------ ---------•--------------•---------------------------------•--------------------------- ......... ---------- -- --------------•---- ----•--.� ----•------------•-------•------------------------------------------•------------------------------------------- ----------------------------------- - - - I here b ertify a+ I have pr pared this p application and`that the work will be done in accordance with San Joaquin County ordinances, to s and rues a d reg la+ions of the San Joaquin Local Ffealth District. ---------- - ----- r: - ----------- (Signed) Contractor - (Title] (Plot plan, showing size of lot, location of syste n elation to wells, buildings, ., can be ace on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------------ DATE.... �� `— ----------- REVIEWEDBY-------------------------------------------------- ---------------------- DATE BUILDINGPERMIT ISSUED--------------------------------- ---------------•--------...----- ------ DATE----------------------------------------------------------- Alterations and/or recommendations----------- ------------- ------------- - --------------- -------•---------------------------- ----------------------- ----------------------------- j ------------------- -- ------ -- ---- ------- - ------------------- •----------------------------------------------------------- --------------------------------------------- --------------------•--------- ------- ----- --------•- ------ ------------------------------------------------ _______________________________________________________ . �1 �� --.. ----------------------------------- Date... FINAL INSPECTION BY:... _- _. _ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California `,S-9-21M 145446 PTwono 12-54