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APPLICATION FOR SANITATION PERMIT Permit No. _ _ - -------- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health Disfricf for a permit to construct and install the work herein described. This application. is made*in compliance with County Ordinance No. 549. JOB ADD E55 D OCATION � `" f - - Owners Name-------------C---lar-- ------e-nce---- ------Ble------ tve ------------t = --------------------- ------- - - -- ------ -------------y--------------------- Phone----..�-3----1'7------------ Address--------------------/-344 � �.Cr c ' - - ----------------------------------------------------------------------------------•--- Fred M. Brown & Sons jj115$2 Contractors Name---------------------- Phone-- --`�--------- ,r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: __ __ Number of bedrooms 22 Number' of baths _ -____=Lot=sizes $ 'e_s___._-_�___ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ® Gravel ❑ Sandy Loam a Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes [2 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:' Distance from nearest well__6o__ftDista ce from foundafion__35---ft -Material------Concrete__---_---_------- � No. of compartments-----------2------------Size__-_--1-X7 --------------0----------------Liquid depth-----�-----------------Capacity-8U0 -gAl l' Disposal Field: Distance from nearest well---7a---;U.0istance from-foundation__25__!'tq-Distance to nearest lot line-__5a___ t Number of lines----- Length of each line----1_1_0_'_---------------Width of trench----2 Type of filter mafif�� -_ bepth of filter material __ _ ____----------------------- O _______________ gth_____ �0_e__ _____---- �{. --- Seepage Pit: Distance fo nearest well----------------------Distance from foundation--- ----------------Distance to nearest lot line_________________ ❑ Number of pits-------------------- Lining material------_----------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--_--- -------------.Lining material----_________________________-_____. .S ❑ Size: Diameter--------------------------------------Depth D�sta'� ny"ce froibui dapacitY- gals. h Priv Distance from-nearest"well ________ � Y• � ❑ ------'Distance to nearest lot line----------------- ------------------------------------------------------------------------------------------------------------------------ Lj Remodeling. and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------•--••------•--•---------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 fhe-San Joaquin Local Health District. (Signed)----Y= F e-d M. Brown � So S------------- -----------_-------- -- -- ----- ---------------- - = ------- ----------------------------------------- -------------------------(Owner and/or Contractor) ° Partner ---------------- ---- (Title) -------------------- (Plot plan, showing size of lof, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' 'FOIL DtPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- -- ---------- -r------------------------ ------------ DATE------- REVIEWED BY--------------------------- -------- -- --- - -- ----------------------------------- DATE-------------------- -- ---------- r, 611.1.LQJ.NG Pr RM_.-_IT ISSUED___ _: - —: - _.- :: �..� = DATE_= _ Alterations and/or recommendations---- ---- - - ---- ------- ------ - ------------------------------------------------------------------------------------------------ ------- -------------------------------------------------•-•----------------------------------------------------------•------------------------------------------------------------------ ------------------------------------ ----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ - --- — —� � � FINAL INSPECTION BY:- -- ----- Date----------- ------------ ------------------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California .. c s ES-9-2M 8-51 Revised W-2100 {