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E APPLICATION FOR SANITATION PERMIT Permit No. __.. • ._��_ - �S (Complete in Duplicate) Date Issued ....... _ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made iri` compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---•------------!_._ 4-- --------------- --- ------- - Owner's Name----- J 1 j - Phone-------------------••------------•-- Address---------------- ---------- Contractor's Name ------------ • --•--- Phone------------------- !I 4 Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /---- Number of bedrooms --VL.- Number of baths _1___ Lot size.______1__ �( l_ _ _:-------_ 0 Water Supply: Public system ,_ Community system ❑ Private ❑ Depth to Water Table g�4_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ER_ Hardpan E] Previous Application Made: Yes ❑ No K- New Construction: Yes ❑ No TYPE OF INSTALLATION'u AND SPECIFICATIONS: (No septic tank or pesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -__-.. Distance from foundation____.-4�------.Mat rial-_____ Nis ocompartments--__. l- 7 __--2. - _ ' --__ -_......___ -__ __- quep ... __._Capacity______ � Disposal Field: Distance from nearest well_-A/drs.-Distance from foundation__ FO_-f---..Distance to nearest lo} Type oNumber of lines---------- _ Len th of each line___._ �} 6____I.,,____-_.Width of french------- 57 �y --- g aG-- yp u' filter material--/.1-----1rR-_Depth of filter material---49__._____--Total length----------------------------------------- Seepage Pit: Distance to nearest well___A/lls�istance from foundation__--- --____.Distanw to nearest lot line_-.__.fid_._ Numb l`r of pits----l---------------Lining material----- G_�f WDiameter----- - --------- -------Depth.._c � j__________------ Cesspool: Distance from nearest well_________________Distance from foundation-_-_____._.._____lining material---------------- --.__..____________ El Size: Demeter.------- Depth -----------------•.._Liquid Capacity---------------------------gals. \ Privy: Distance from nearest well.................-_------ ----------------------Distance from nearest building_____________________________ V ------------ ❑ Distance to nearest lot line-- --.------ Remodeling and/or repairing (describe):-------- --------------------------------------•-------------------•---------- --------------------- -----------.------------------------ ---------------------------------------------------•-----------11------------------------------------------- -----------•---•---•----------••-------------------------•-------------------------•-----•----•--------•------------------------ •--------------------• -------------------!i - --------------------------------------------------------------------•-----------•-•-•-------------------------------------------------------------------------------------- - ------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------•---------------•---------------- I hereby certify that Iihave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Ii (Signed).... --- li't� �--------------------------------------------------•------------ ((Awner and/or Contractor) By:p_ ems ` --- = --------------------------------------------(Title)--------15! ----- -------------------------------------------------- y � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION -•- --- -- --- ---- ----------- ---------------•------------------------------- DATE------ REVIEWED BY- ACCEPTED 13Y----------------- -- ------- DATE--- BUILDING PERMIT ISSUED:------------------------------- ----- --- - DATE--- ------ __ ---- �� Alterations and/or recomme dations------------- --- V----------- -- ---------------- .- -� , ------------------------ `.' en �q f --- ------------ -------- ��-_-•--- ------------` ---•--.:.A'..._ - __ --- ----------------� 1-------------"----- -_------------------ - - - - i1'---------- --------=-....."- -------------------- -------- ---- \i---------------------------- I--------------------------------------------------------I----------- FINAL INSPECTION BY:----------------- ------- ----- ZDate_-�,. I� �I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street's 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446-TWA0- 12-54