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v , APPLICATION FOR SANITATION PERMIT` � �ermit No, +�� (Complete in Duplicate) C 7 p ``__� Date Issued Applica on hereby mad to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicat;o is made i compliance with County Ordinance No. 549. 1 JOB ADDRESS AND LO ATION "7 S "------W, Owner's Name:__( -I b/_ ---- ---------------------- Phone . -------�--------------------------- --- ---------- Address--__.4(_ ---Z-------•-11011`--------- -- --------------•- --- Contractor's Name___ --- ----- - ----�--"�------------- ---------------- Phone-- __ ., _' Installation will serve: Residence A- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j-__- Number of bedrooms - -- Number of baths -_ _.- Lot size -__ Water Supply: Publ;c.system 9G'ommunity system ❑ Private ❑ Depth to Water TablecJ 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe rdpan ❑ Previous Application Made: Yes ❑ No 4" New Construction: Yes [I No ��" r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t. Septic Tank: Distance from nearest welLrc--Distance from foundation___-O_ --.Material____ ----------------- No. of compart lents_.._._._.-�_-_-------Size_,��-.X_3 ------Liquid depth----- --------------Capacity-- ri4 , �N Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line____________.___. c ❑ Number of lines-----------------------------------Length of each line-----_-----------------------.Width of french------------------- -- ' pfilteal r +th ffilter material � Total length------------------- See a e Pit: Distanccetoneastwell_. 1 ` Dsancefrom foundation___--� __ _ f Distance to nearest lot I;ne___ �- Number of pits_!_____/____ . Lining matenaL +- _-.Size: Diameter_.r��---"�-----------Depth__. I Cesspool: Distance from nearest well--------- ._Distance from foundation___________._.___.Lining material_____________ ____________ a ❑ Size: Diameter_ ------------- ------------------ Depth----------------------------------------- ------ Liquid.tCapacity `-==---gals- Privy: Distance from nearest well------------------- ------------------------------ --------------- - ._. __-____._Distance from nearest building.t_ ____._.__.___- ❑ Distance to nearest lot line Remodeling and/or repairing (describe):_. �. .. —-__ ----- I ---------------•-#-----------------•--------------------- ------- ----- ----- ---- -- ------ ------ ----- • -- - ---- - • --- --- -- -------- I hereby certify that l 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 Jouin Lac I Health District. (Signed) �' aq ( fQ Contractor) 1 ------------ -------------- --�.."------ r By:------- -- ---------•------------ - -- - - --------------------------------- -------------(Title)---------- ------------------------------- ------------------ (Plot plan, showing size of lot, locafio+ of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------I------- ---•---------------- DATE-----_-- --- ----- --_-- a - ----------- P BY ------- ---------x - ----- DATE-------- - - -----•------- BUILDING PERMIT ISSUED----------------- -------------------------------------------- --------- ---- -------------- DATE A aerations and/or recommendations:_;_______________. --------------------------------------------------- ----------------------------------------------- • ---------I-------------------------------------------•----•--- - .-•------- -------•-------------------------- ---------------------- ---------------------------------------------------•------------------------------------- 3 l FINAL INSPECTION BY------- --------------d��- �� " I-------- Date------------- .._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sheaf 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9--2M 10-52 Revised W-2100