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tl` ' APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) Date Issued7..a-A/ �A i'ticeion 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 LQ CA ON--•-111 01.0 -- '------------•----------- --------------------------------- Phone..-F_a�- � Owner s'Name-------- -- ----- -`-------- 7 Address----- -- ----•------v.0....._-- •-------------- .------------------ ------------... -------------- - -------------- Contractor's I\lame �j ----- '` = Phone--l..� a Installation will serve: Residence [y�Apartmen# House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..�. 'Number of bedrooms __c4. Number of baths ___41_ Lot size !b---X.l0----------•------------------------ f `l Water Supply: Pbblic system-Community sysfem ❑ Private ❑ Depth to Water Table .T-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2---H rdpan ❑ Previous Application Made: Yes ❑ 4No �ew Construction: Yes ❑ No [9 ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic}tank or cesspool permitted if public ewer is available within 200 feet. Lest ._Distan % from foy ndation__--14---.....Material .. ' '�----------------- Septic nk: Distance from nearest well. r� Q- r , ------ Siz .X � b,3 Liquid depth °�� Capacity9Qd.�.l 1 � No. of compartments................... Disposal Field: Distance from nearest well _� -D�sta�c from foundation_--5'd--------Distance to nearest lot line-----..-- - f a -- Number-o-i Iines�= 1-----r- C��L �gt o each line--:--� ----------„------Width of french--- --------------------- Type of filter material _.. -Depth of�filter material.....-_��..__.._. Totallength--_.......�.�_---- ------------------ Seepage Pit: Distance to nearest well ------ `"_...---..:Distance from fou ation-__.._ (�_.�.....Distan�e to nearest lot line.. __ z • _- Size: Diameter-----s7j.-_ Depth.......A�- Number of pits--�------l----------Lining material. �.---- _ - ------ i y Cesspool: '” „ Distance from nearest well._......-._..._-Distance from.foundation.-__.....-__.....- Lining material_.___................................ ❑ Sizci Diameter--"---------------------------------Depth------------------ = Liquid Capacity gals. - -------------- - - F Distance from nearest building_.....-- Privy: w. Distance from nearest well-------------------------------=-------- ❑ Distance o nea ' rest lot line-------- ._ ---------------------------------- ---------------,-�--------------------------------------------- 1 -,.0- - .- -------- Remodeling and/or repairing (describe): l { ..._----•---- -••-------••----- -•----------t---------------------•--------- --------------------------- - •----------•--------••------------------------•------------------------------------------------ --------- { =----------•---=---- ---•---------•------•------ 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, `I ~ , - i (fie and/or ontractor) (Signed)_ By:. -•-------tom:/-- • ------- ---------------- --------------------------------- (Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE -------- -------------------------------- REVIEWED BY------------------------------ --------- DATE... ---•--------------•---_-------------------- REVIEWED PERMIT ISSUED = DATE-------- -------------------------•--------------------- Alterations and/or recommendations:------------.---- ----------------------------------------------------------- ------- ----•--------. ----------•------- ------ ------- --------------------------------------------------------------------- --------------------- -------` ------------------------ ----------------- FINALINSPECTION BY:...--------t-------•- -----•---------------- f Date--------------------------------- ------------ ------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT BO 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