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APPLICATION FOR SANITATION PERMIT Permit No. 4"--7_____ _____.. t� ( (Complete in Duplicate) Date Issued �.- . ...-� - Applica+ion is hereby made to the San Joaquin Locaf Health D' trict for a permit to construct and install the work herein described. This application is made in compliance with County Or 'nan No. 549. JOB ADDRESS AND LOCATION ` �r--------- ------•. - .---- ---- 1 - ---- ---------------------------------------- . # ------------ ------------ Address Phone..-= Owner's Name------------------------------------------- --- - - -- --- - -------- Address----------••--------------------------- C -1 e*77_�---------------------------------------------------------------------------------••-------------- ------ a Contractor's Name--------------------------------- Q - -- -- ------------------------------------------------ Phone...9~P-4A ------ I Installation will serve: Residence,( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: _ --- Number of bedrooms- -- Number of baths __f___ Lot size ------------•-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table4/vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ r > G� Previous Application Made: Yes ❑ Nc,�C New Construction: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { C Distance from nearest well_________________Distance from foundation------------------.Material------------.---__--__-________________________. No. of compartments------------ - -----------Size--------------------------------Liquid depth--------------------------Capacity----------------- gosal�F d: Distance from nearest well.—.-_Distance from foundation_-Z�_____-___Distance to nearest lot line.__Af Number of lines______:______ Length of each line_�.Q_'-_______________Width of trench Z!k�----------------------- Type _'_- ii.r�7RK �- f Type of filter material--- 9�_____ -------Depth of filter matenal___--� ___________Total length_,�_4_ _____________________ .r Pit: Distance to nearest well-!`ti�!______Distanc em foundation__ ______.__.Distance to nearest lot line_ ------- Seepage Number of pits----I----------------Lining material lGle _,_____size. Diameter- ' ��__.-___-.Depth_ tea��______ well________________Distance from foundation--------------------Lining material___-___________-________-_______--___ Cesspool: Distance from nearest El Size: Diameter------------------- ----------Depth---------------------------------- ---------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest we1L------------------------------------------------Distance from nearest building________--.--fi:- ____________________. ❑ Distance to nearest lot line:_______________________ Remodelingand/or repairing (describe)---------- -----------------------------------•-••------------------------- •-------------•-------•----------------••--------------------------------- - ---• ------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------••---•--------------•------------------___ ------------------------------------------------------------------- -------------------------•-•------------•---------------------------------------------------------------------------------------------- -------------- I hereb ertify +hat i have prepay d this application and that the work will be done in accordance with San Joaquin County ordinances, t to laws, d ruIn r� ulations of the San J aquin Local Health District. �� •----------- Contractor) {Signed)- j �!'+� M1 ----------------ITitle) , _l lr1'll R ------ I ..� (Plot plan, showing size of lot, location of syst in relation to wellf, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE,ONLY , I s APPLICATION ACCEPTED BY--- ---------------------- - ------ ---------------------------------------------------------- DATE-it? _ ---------------------------------------------•---- DATE—.*-! V-----------------•---------------------------REVIEWED 3Y- , --------------- BU1LDlN PRMITlF!ISSUED ^ --' .. --- ------------------------ -- DAT-E----- --- �-•------------ = ----•-------------- - •---------------------------- Alterations and reco en ns:. _._.. - --------------- -------------- s l- d "----------------------------------------------------------------- ------------------------------------------------------1- ------------------------------------•------------------------.. FINAL INSPECTION BY--------- ------- -------------- Date------------ �7� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100