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Krl- � VZ v APPLICATION FOR SANITATION PERMIT Permit No. {Complete in Duplicate) Date Issued/ /Z--.�., Application is he / pp reby made 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 No. 549. P JOB ADDRESS AND TION_._____, ____ ____________________________________________________ Owner's Name__._--_____ VC ---- - ------ - ------- - --•- ---------------- -------------- . Phone-- �� Address [/ ---- -- ----- ----- --- - Contractor's Name_____ --_- -------------- •-------------- -- _ - ------ Phone__/:_�_�1_2_4--• --- ---------------------------- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ ❑ Trailer Cour} ❑ Motel ❑ Other Number of living units.,/---- Number of bedrooms ._� Number of baths -/. Lot size ----7-s", --_ R G r ----------------- ater Supply: Public system ❑ Community system ❑ Private j�' Depth to Water Table a �i-_ ft, i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy -Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ -INo� New Construction: Yes�' No E] 1 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___s dDistance from foundation---A!r_" .Mater�l____.____ No, of compartments-------C,-----------__-_Size__j�74-X-yOYX. Liquid de +h_____ "" ej • q p � �------ - -Capacity--- �-'----- ---. sposa Field: Distance from nearest 11---- Distance from foundation--��-_------Distance to nearest lot line_--�f-- ---- Number of lines---------f-- ----------------'`Length of each line_ 0�3a'_306;"Width of french-----:�_�_"�-._____.- ----- Type of filter material---St_�f.C Depth of filter material___ __.Total length______ -tea ---------------------- Seepage ---_Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________Distance to nearest lot line__.-___._________ ❑ Number of pits----- ----------------Lining material------- - --------- _Size: Diameter Depth k Cesspool: Distance from nearest well_________________Distance from foundation_____________ .__. Lining material-------------------------- FJ DiameterD ----------- ------------------- p ------------------------------ ------------ --------Liquid y Capacity------------------------ gali Privy: Distance from nearest well __----------------- Distance from nearest buildin❑ Distance to nearest lot lineg ----------Remodeling and/or repairing (describe)____________________________------------------------ •-----------____________________________________________________________________________________________»_______-_____..______--__-_._.._______-____.____.-_______.______________________._.____-_________________--__________.___-' lit I hereby certify that I have prepared this application and that the work will be done in accordance with S'an Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Y : .� (Signed)-. O , er and/or Contra or] -------- ; SY� •�f..r�..!' --- ----------------------------------------------------- (PlotTitle `I� ,i plan, showing size of lot, location of stem in relation to wells, bu I ) - p g ildings, etc., can be paced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_________________ _____ __ � ----------------- - ------•--------- -----------------------------•-- A---------- DTE----- •-- ---REVl=WED BY BUILDING PERMIT ISSUED ------------------------------------------------------------------------- ` , -------------------- DATE------------------------ ---- ---------- -- — DATE nd/ar re a ations: ----------------- ------ _ ---------•----- , IE __________________________________________________ __ _._.___________________________________--_--------------------------------------------------------------- _______---____ _ _ FINAL INSPECTION BY: �� --------------------- Date----! - ---- 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 ES-9-2M 10-52 Revised W-2100