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APPLICATION FOR SANITATION PERMIT7j Permit No, vt_______________ 0 (Complete in Duplicate) + Date Issued pplication is hereby made jo the San Joaquin Local Health District for a permit to construct and install the work herein described. ,Thi, a pplcafion is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION-------7547--f�" x+__y_t-_------------------------------------------------------------------------------------------ -------------------- Owner's Name----------- _!1r-s-`--_Dia t ` `3"Q ?'. --------------------------- Phone_-- 2==9_14Q-------------- k - _______________________________________________________________._______----_________________-_-__________________-____________________________________ ________________________ Contractor's Name----- --_' 'D-e—U---------------------------------------------------------------------------------------------------------------- Phone---------39 -----------: Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: --I__ Number of bedrboms __2__ umber of baths ---I-- Lot size ---15Q__X---1 ------------------------------ Water ___________________ _--_._ Water Supply: Public system ❑ Community;'system '❑ Private.-Q Depth to Water Table3.51_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E] Hardpan ❑ Previous Application Made:l Yes ❑ No E New Construction: Yes ❑ No A: I TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) NI ) Septic Tank: Distance from nearest well_________________Distance from foundation__-----------------.Material________----___________________________________ F i ex�till- No. of compartments--------------------------Size--------------------------------Liquid depth---------,----------------Capacity--------- ---- ---- ! Disposal Field: Distance from nearest well-________________Distance from foundation_____,._--_____-___Distance to nearest lot line------------------ v Number of lines-----------------------------------Length of each line-----------------------------.Width of ,- _ trench----------------------------------- Type -------------------l---i----f- ----Y}- _-_-_- YPofflter material__________________ Depth of filter material________________--_.--Total length___________________-___-_,---_________-_ ! Seepage Pit: Distance to nearest weli_______�� Distance from foundation--I0 to nearest lot line____.____ Number. of pits-------Z___-------Lining m rial-_?x��______5ize: Diameter,__.__L ...........Depth- _ _ -�_-____-_----_____� - Cesspool: Distance from nearest well-----------------Distance from foundation__________________.Lining materia-------------------------------------- Size: Diameter--------------------------------------DeP -- --th--:---- --------------------------- -.---.Liq.uidiCapacity_-_�..=-�:_�' ^c3a� . _ r ;=—privy:- -Z, Distance from ne rest well--- ------ --- ''-- Distance from nearest building----- -------------------------------- ❑ Distance to nearest .lot line-=------------------------------------------------- --- -- Y=----------------------- ---------------------------------------- Remodeling and/or. repairing (describe)----------------------Zl "itra,—1i'C?g---Yaw'�ra��__C�S'�??n--- ------------------I----------I------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------I-------- ------------------------------------------------------------------- .., i 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. ' (Signed) leap=------------------------------------------- -- ------------------------------------------(Owner and/or Contractor) �Y� � '�'�T-T. .r F1 n- - {Title)------Q1 : e 'ss�� ' • _- - ---------------------- (Plot - --- (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). ., I FOR DEPARTMENT USE ONLY - r VIEWED BY_-•-C -- '- BY -------- ------------------------------------------------- DATE ,----- ------------------------------------------ k APPLICATION ACCEPTED------------ --------------------------.-------------------------------------------=--------- DATE----* ---- ---------------------•-------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-- ------------------------------------------------------ Alterationsand/or recommendations---------------------------- ------------------ ---------------------------------- -------------------------------------------------------------------------- -----------------------------------------7-------------------------------- ------------------------------------------------------------------------------------- ii F � .i ---------------------------------------------------._--_________.________..___-__________.____----___-_____________________________.___-__________._______________________.___--_____________________________________________ ______________________________ ______._'------------------------------------------------------------------ ----------------------------------------'----------------------._______________________________________-_.-.. .. FINAL INSPECTION BY:---- /t/_t_ Fl.= '---------- Date �F,��CC 1j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" Street y Stockton, California Lodi, California Manteca, California Tracy, California E5-9-21vS 8-51 Revised W-2100