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APPLICATION FOR SANITATION PERMIT Permit No. ___-31k___ (Complete in Duplicate) f Date Issued Applical-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 in compliance with County Ordinance No. 549. JOB ADDRESS AND CATIPN----� � .-- p 4 Owner's Name �i --;---•------------------------------------------------------------------------- ---- -- Phone -----------•------- --------------- Address!-! �1'%C•------------------------------•--------------------------------------------•-- ------------------------ Contractor's Name �' �' --- ---•----- Phone ----------------------------------- Installation will serve: Residence �-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [-I Other ❑ Number of living units: j___ Number o£ bedrooms - .- Number of baths /-___ 'Lot size __ _ _ 1_tr -------------------- �*------ Water Supply: Public system 9_1 ommunity system E]Private [-]Depth to Water Table " ' ft Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Yy'Ld�m Clay Adobe and an P ❑ ❑ Y ❑ ❑ Y❑ �� P ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: y 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _?;__-Distance from foundation-__V"_r._. Material____e—e-_._ -4 ,---. No. of compartments. -.--R-. -- --.--Size--- 4.'LP'- -- ©----- Liquid)-d,pth__ - '-<------.-Capacity--- Disposal Field: Distance from nearest well_) "—L Distance from foundation!_ --- Distance" to nearest lot line ------- ---._____ Number of lines_______________________ ______ �ength of each line____'©__._________..Wid#h of french ------- --- _______-__-- Type of filter material—/ _ _...: _ epth of ---------- Total length -------- 6'µd --r_._____________-._ � a Seepage Pit: Distance to nearest well_.. `�Di ace from foundation -- _ _.__.Distance to nearest lot line__ 9j*__ Number of pits ----- m t ial_&-c----- •z,: iamet r_- U ---r-.____ Depth ...... Z49 _____.________ Cesspool: Distance from nearest well__________________ stance from �aundatio _. ....... .______.Lining material ------------------------------ .......El ' Size: Diameter---------------------------------- --.D h ----.---------- ------.-- A - ---- ----------- Liquid Capacity... gals. - 4 Privy: ❑ o nearest arest well-------------- ------------ is nce from nearest building -------------------------------------- Distance tlot iine.............L - --- — ----- Remodelin and/or repairing describe ____________ } ------------------------•-•--------------------------------• -------------- ...------------------------------------- -------- i ; S I hereby certify that I have 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. ------------------------- (Signed) ----------------r/" Ark - --- - ---- ----- -- -- -------,-j-f ---- -----' --------- -- �j*fir Contractor) By: ----------------------------------------- Ix �--- � �'---------------(Title)------ (Piot plan, showing size of lot, to ation of system in relation to wells, buildings, etc., can be placed on reverseride). 9 i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------------------------------. DATE.-------------------- -- ---------------------------- REVIEWEDBY----------------------------------- - ------------------------------------------------------•---•-------------------- DATE ---------1 S BUILDING PERMIT ISSUED------------ -- �----------------------------------------------- - ------ DATE --------`1------------ ---------------- Alterations and/or recommendations:--. --------------- ----------------------------------------------------------------------- ----------------------- ----------------------------------------------------------------------------- -------•------ ----------------------------------------------------------------------------------------------------- --------------------- ---------------------------------- ------ ----------- -------------•-----._...--------------------------------------------------------------------------------------------------------------------------------------------- FINAL, INSPECTION BY: --------------------- Date- - — ---� ------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT �N r 130 South American Street 300 West Oak Street 132 Sycamore Street "-814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446-Arw..7PO p.