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APPLICATION FOR SANITATION P61RMIT Permit No. ._-- ?.. Clu Duplicate) y` - (Complete in Dp• } Date Issued -----9__------7 3�, Application 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. -------------- 11J JOBADDRESS AND LOCATION------------- L --------- ------------------------------------------------------------ Owner's Name ' 4 Phone-------------------------------- Address-----------------------------------------= ��}t,-- -------"---------------•--------------------------------------------------- -----------------------------------------•-- Contractor's Name----------- -------- Cas' �. '`------------------------------------------- Phone Installation will serve: Residence (��A Commercial ❑ Trailer Court E] Motel ❑ Other ❑ 1 partment House ❑ ommerc -- Number of living units: __!-____ Number of bedrooms _1_-__ Number of baths 'Lot size _____ ----------------------- Water Supply: Public system W--community system '❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2--trarclpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1, (No septic tank or cesspool permitted if public sewer is available within 200 feet1�1_ Se tic Tank: Distance from nearest well___`'______Distance from foundation_LO_ Mater al '. ---- -- --- ------ -. ----- No. of compartments--------_ ----------Size---- --.y__d-�Z------.Liquid ------------ Capacity----- Field: Distance from nearest well"_" __- ---_Distance from foundation ____ __-- D'sstance to nearest lot line____/_c�'___� umber of lines------------ -- ------------ --Length of each line------- <� N /. l"i Width of trench----------� ---------------- 30 Type of filter material_____ ___ ,Depth of filter material-----__- ----------Total length-------------2 __ ------------------ Seepage ________________ _________ _Distance from foundation--------------------Distance to nearest-lot line______-----______ ❑g Number of pits----------------------Lining material--------_--------------Size: Diameter-----------------------Depth---------------------------- Cesspool: --------------------- t See a e Pit: Distance to nearest well__-____-_ g ---------- Cesspool: Distance from nearesF well___-________.___Distance from foundation-------------------_Linin material- ___-___-____- ❑ Size: Diameter--------------------------- ----------.,Depth--------- ---------------------------------------------Liquid Capacity---_- _-------------:-als, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 1771 _____________________-_❑ Distance to nearest lot line-------------------------• ---------------------------------------------------------------------------- ------------- Remodeling and/or repairing (describe):--------------------- ------=--- - - - -- ---------------------- ---- ------ 477. - ------------ 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 ooff+he San Joaquin Local Health District. (Signed)---�. � --- ------� �" --------------------------------------------------- - (Owner and/or Contractor) g : / -------------- ---c- - --------------------------------- Y• ------------------ (Title} ' Ct• (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- -----------------------I------------------------------------------------------------- DATE--- ------------------------------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE-------------------•------------ -------------------------- BUILDING PERMIT ISSUED------------------------------------------ ----------------- DATE------------------- P-- ------------------- -------------- } Alterations and/or recommendations:-------------- --------- ____ - -- ---------------- --------------------------------------- r - =�� _- = -------V-6--------------------------------------------- --------------------------------------------------------------- ----- FINAL INSPECTION BY:-_--- ��-�r--- --ri�- -------- Date ----I .3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C' Street } Stockton, California Lodi, California Manteca, Calif6rnia Tracy, California ES-9-2M B-51 Revised W-2100