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e, APPLICATION FOR SANITATION PERMIT Permit N5Z,;3-• __7_ ' f (Complete in Duplicate) �J Date Issue ------Z O4, 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. JOB ADDRESS AND LOCATION---910710 ?" e__,(,dw- Owner's Name---•--------•---------------- - -- - - - - --------------------- PhoneAddress -`-. .f`O[? ------------------------------------------------- ------------------ Contractor's Nama_______________________ r!'� 4i r-- -------- ---------------------- Phone-- Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--_ Number of bedrooms -/_- Number of baths --/-- Lot size ----------- ater Supply: Public system ;�L Community system fl Private ❑ Depth to Water Table' Vft./p&-sJ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [6 Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No j( TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c• ` Septic Tank: Distance from nearest well-----------------Distance from 'foundation-------------------- (v�~ Material---------------- - No. of compartments--------- -- ---Size--------------------------------Liquid depth------- •----------------Capacity Disposal Field: DumL>ee'from nearest welL_____ __Distance from foundation--------------------Distance to nearest lot line----------------- Type Number it lines e - l-------------- _--Length of each line------------------------------Width of trenc4,---------------------------------- ----------of filter material-------------------------Depth of filter material-----------------------Total length-----------------------------__---------__ Seepage Pit: Distance to neares well_A*7>k/-- Distanc fro foundation-/ ---- is ae to nearest lot line_- �,__---_ It Number of pits-- ------------------Lining matetial-144 • -------++,�-----Sze: Diameter------�-------- --.Depth_��P---------- _ ----------- spool: Distance from nearest well-----------------Distance from foundation----___------ Lining material ---------------------- Size: Diameter Depth -----=°_` --------------------- Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------- Disfiance from nearest building El Distance to nearest loft line-- _- Remodeling and/or repairing (describe)------------------------------------------------------------------------------ -------------------------- ----------------------------------------------------------------------------------------•-•--------------•---------------------------------------------------------- -•--------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsAnd rules and re lations of the San Joaquin Local Health District. (Signed)---- `--- ` f - ontract C� I�w C or) By: (Title)--- r2 - --- ------------------ (Plot plan, sho (Title)--- it size of lot, locati of system in relation to wells, buildings, etc., can be placed an.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --- - -------------- --- - -- DATE REVIEWED BY------------------------- ------- - --- - - -- ------------------------------------------------- ------ - - DATE--- BUILDING PERMIT 155UED------------ --------------_ ?'� ---- �-- -------- - ------------------ --------- ----- 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,--Galifornia Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100