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1 ' . APPLICATION FOR SANITATION PERMIT Permit No.�7�.0_p _ [u v I (Complete in Duplicate) I! - � .. .3. .... Date issued/_/__7,3:-�_r Applica{ion is hereby made to the San Joaquin Local Health District for aj permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.. _- - "-___ - - ------------------- -- -------•--------------•-------------- ----•---- Owner's Name---y--.5 - ..±1_ ._ = r.�'t _ `r __ PhAn 7 1 Address.............. ?Contractor's Name... r .j�l. - ----------- - % one ---------- Installation will serve: Residence EkApartment"House E] Commercial [-1Trailer Court E] Motel ❑ Other [3a� !! 10 Number of living units ---I--- Number of bedrooms -)------ Number of baths -_I____ Lot size Water Supply: Public system,�X Community system ❑ Private'❑ Depth to Water Table -------- f+. Character of soil to a depth of 3 feet: Sand Gravel hSand'-Loam Clay Loam Clay P N ❑ ❑ a y ❑ y ❑ y ❑ Adobe Hardpan ❑ �N Previous Application Made: Yes ❑ NoNew Construction: Yes ❑ No •; 11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance fiom nearest wellN A-?'Lk-,Distance from foundation_ .. depth---�:----------------Capacity...ii-Q------ Y�S � Ic l r is osa ie Distance from nearest well..................Distance from foundation-------.------------Distance to nearest lot line____________..___ Number of lines______'_______________ -------------Length of each line----------------------_ Width of trench-___--_______ Type of filter material----- ------ CC -_-___ ---Depth of filter°material-----------------------Total - ------Liquid Capacity Seepage Pit: Distance to nearest well_-_._-r'`:-__ -__-_Distance from foundation_____________�__ Distance to nearest lot line----------------- ❑ Number of pits--"_:_I-------------Lining material-----------------:-----Size: Diameter------- ----------------Depth------------------------- -----"- I Cesspool: Distance from nearest,welL -------------Distance from fouridation._._.___.___--_:_.Lining material-------------------- - - ❑ Size: Diameter_____. y. Depth:. - y- --•----- gals. Privy: Distance from nearest well_::--..._:'~'______________ Y__-__-__-__.____Distance from neatest building _.> . ----------------------------- ❑ Distance to nearest lot line________________________. - rt Remodeling and/or repairing ( e Bribe):----f,,-_ -C-�-- --- 1,G--- ---�-- -- 1- - - -- `it 7S V (,3 f�� --------------------------------- 11 h.. . : --------------------------------------------- - y I hereby certify that 164 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: {Sined +! f,- �' g l - +-- --- -(Owner and/or Contractor] By:.--------------- ---------- ----------------------- =° Title or ------------------------------- --------------•---•--------- -------- { � }------- - ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,'can be placed on reverse side). = r C FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- ---- ------------------- - - DATE--REVIEWED BY ' ------------ --- '� DATE------------- ----•------------------------------- ------------------------------ --- ---------- ------------------------------------------------- A --------------------------------------- -------- BUILDING PERMIT ISSUED-- ------------ - ------- - ------------------------------------------`--- --------------•------- Alterations and/or recommends ions---- ------------- � ------------------------------------------- - -----------------------------------------------------------•-•------------------------------ . --------- ---------•-•-----------•--------------------------- FINAL INSPECTION BY:. . -_ --- ------ ---•---------------- Date. �_ = J ----•--"------- ._ II SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+teat 132 Sycamore Street 814 North "C" Street 9' Stockton, California .� Lodi, California Man+Bee, California Tracy, California _ ES-9-2M ; Revised W-2100 ii