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APPLICATION FOR SANITATION .C�,' PERMIT � -.b:-�•l_ (Complete in Duplicate) Permit No. �_ —�w--y- -�- Date issued pplica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. This application is madealin compliance with County Ordinance No. 549. —363 ho TION r 1�'� f lel a Owner's Name---- - k / = JOB DRESS AND LOCA Sr. .. rY'.i�rt ,7=-------------- ------------ �- -1. �1///- --------- Address------- Y ------------------------------- ----- Phone----------------- --_------------- -•--------•-----------------------------------••-------•-------•-------•-------------------------•-------------•-•-------• ----- --------------- Contractor's Name--t-------------------- -� ------------------------------ - Installation will serve ,Res;dence ' Phone.-----•-------•--------- ----------- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of'livingunits: -------- Num ler of bedrooms ---3- Number of baths _ Lot-size --- Water Supply: Public systemCommunity 1' Q --� 2 ------------ ppy' F �_ ❑ Com unity system ❑ Private Depth to Water Table _� ft. Character of soil to adepth of,3,feet:_Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Previous Application Made Yes o Hardpan ❑ ❑ NNew Construction: Yes No ❑ (', TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) // � I Septic Tank: Distance from nearest well----L-C------Distance from foundation-- ` NO'.—Of compartments > _ r� { Material ?� _G u`T . . `�V 3 p _ ---Size..... 1r �A - t � � r --"t- -��`-------Liquid depth--------`]�-�.- --------Capacity J"G! D;sp'osal Field: Distance from nearest weil---- Distance from foundation-----�-L�-f---_-Distance to nearest lot line---------------1. -- d Number of lines----__-- � . Length of each line_,Z �TCL'_) -.---V/;dth of trench.-__- ---'- �� Ty, filter material_-- ---__- --- Depth of filter material----- "'. f fe. --------Total len-gth-----------I�Lf------ Seepage Pit: Distance to nearest well----------------------Distance from foundati ----------------- to nearest lot line ❑ Number of Pits-----------------1�1 -- material--------------------- -Size: Diameter------------------ Depth Cesspool: Distance-from nearest well----- --". ----- ---- ---------------------------- ❑ 5ize�:'Diarrieter-_--- f wel :j•- m,",-Distance from foundation--------------------Lining material---------------------- Depth--------------------- ---------- -----------------Liquid Capacity els. T - g Privy: Distance from nearest well.-____ :: J._:------------------------------_-_--Distance from nearest building ❑ Distance to nearest lot line- -? ------- g :_- ---.. --------------------------------------- --------------- -------------------- ----------------- Remodeling and/or repairing (describe)-----------------------1.1 - ----------------- i ------ i -------------=----------•- --------------•--.-- I hereby certify that I have prepared this appl'c9'tion and that the work will be done in accordance with San Joaquin County ordinances, Stat laws and r and reulationsfhe San oaquin Local. Health District. (Sign ed F - - - - -- -- --------------------------------------------------------••--------- --(Ow BY�-------•-----------------------•----= + her and/or Contractor) ------------------------------------------------(Title] Plot plan, showing size�of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ! ' REVIEWED BY ; " DATE ----- -- �- - - x BUILDING PERMIT ISSUED--------------•------ ------- --------------------------------------------- DATE ----- -------------------------------------------------- Alterations '--------------- - --------------------- -------- ------------------------------- DATE------------------------ . A terations and/or recommendations:---_- _----- -.--- _--------------- ----------------- ----------------------------------- ------------------------------ -- ------------------- ;FINAL INSPECTION BY--------------- -.11) , ,JJ �� . ------------- Date--- •-----------•---• SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South Amerman $free} 300 West Oak Street132 S ' ycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised W-2100