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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) - bate Issued ___/ r Applica{ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1 �r JOB ADDRESS AND LOCATION---•-�¢---�-7 .---S��p kC'��---- ---/�/��--------------------------- Owner's Name---------- ---------- ------- Phone------------ Address__.---••---------- ee_- `__. ��1 ^"Q _ =r?— j/ - ----------------------------------------------•-------------------------•------•---- Contractor's Name_ '4_6_r� (_d/ ------se_1�°p_.z 6 --------_-------• -- Installation will serve: Residence gr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _Z-- Number of bedrooms -_-- Number of baths . -- Lot size -_-_- ------------_--- Water Supply: Public system ❑y Community system ❑ Private Depth to Water Tablet`- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E❑ No Or New Construction: Yes E] 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-��-------- Distance from foundation-_7th....,.._..Material-_-_lrt-( No. of compartments..__ , _•-Liquid depth.__._ Ca acit Size P Y "�/ro0o - - - ---------- Disposal Field: Distance from nearest well-4,0 ...Distance from foundafion__C�'_ .....Distance to nearest lot lined-_-_-_-_- ` o� -=- bar of lines-------------`�---------------_Length of each line---+ .............-.Width.-.Width of trench------ J Type of filter material_ __ 1 i _Depth of filter material_--_./ _._____._Total. length--__-_a - _------------------------- Seepage -____-_-----_--__- --Seepage Pit: Msfance to nearest well_Z&--._.___ Distance from fou +dation_ .__ � L____ Dist n�ce to nearest lot line______ ________ ; Number of pits._.-___.__._.._____Lining material_fLF�-Size: Diameter... ._._......Depth_--__ +7��..,.-`-------------- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material-__.--._.---_•-___.-_.--__-___ ❑ Size: Diameter------------------ --- ---------------Depth------------------------------ ---------------------Liquid Capacity,--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------ ---------- -----------------------------------------------------=----------- Remodeling and/or repairing (describe):---------- _ ` f >-•- _---.• `j ---------------- -----------•----,---------_-_---•------•--------------- ----- --- - --- ---------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------- ----•----------- ---------- 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)- --------------- ------ - • t -- By:------------------ -••---------- ' . Con ' ----------------------------------------------------- '�- r Contractor) trac r (Title) (Plot plan, showing size of lot,�l ation of system in relation to wells, buildings, etc., can be placed on rever FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- ------- --- ------------------ DATE_-../.-----------•---------- ------------------------------ + REVIEWED BY cs ---- --------- - ----------------------------•-�•-------- DATE-------•- --------------- BUILDING PERMIT 155UED--------- - ------------ - DATE------ -- �------ Alterations and/or recommendations:---.-_.............. ------------------------------------------ :. = ---------------- ---------------------------------------------------------------------- :__ ---------------------- ---------- -------- _ _______________________________________________________ FINAL INSPECTION BY: ______ ---•�------- -------------------------• Date-...- --------------------------------- I f 2� �f 7n n''rr t r,t I �ii✓i C�n�f i°9rw �ts.�, t/.�7 /V F+f2�/,C S•P�.rr� bl r r ._.; ye-. r u G sYS_1_4 , a 1 d SAN JOAQUIN-LOCAL HEALTH DISTRICT , / (x� 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California f `�//�/7 Lodi, California �7 Manteca, California O } Tracy, Celiforn a / 1454x6 n-rwAao r�1f'! r / /l,(/Lr�,o..rP.C�O/ �- GG .(/�,�.G•N�^ l�jQ+� Q +(/,^. �(� Ca �.t�/�j T a q a•o-�' 4A am cap,..�ci� • - � 1l- (�f ��