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APPLICATION FOR SANITATION PERMIT Permit No. ' (Complete in' Duplicate) �I / Date Issued __----- I ' Ierein Applica{ion is hereby made to the San Joaquin Loca# Health•District for a permit to construct and install the work described. This application is made in compliance with County Ordinance No. 549. a JOB ADDRESS AND LOCATION---•-• + - - ------ .. Owner's Name_.___l__�{'_�. _ e - ! -1'At7. Phone__.-. I� ----------------- Address------ i� I� . . f Contractor s Name---- II_Q,: _�C.!_1_t f -= •I-� � Y �'C �'� -----=-------- •----------- Phone-------- 0I` Installation will serve: Residehce A artrn_ t House Commercial p ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:. _____ Number of bedrooms ___- Number of baths ........ Lot size _____________________"________.•.___ Water Supply:' Publicsystem) ❑ Community system a[] Private$Depth to Wafersab'�I�e` ._____•ft. Character of soil to a depth �3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe. Hardpan ❑ Previous Application Made: Yes ❑ No [:1 New Construction: Yes r] No ,C] i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance flrom nearest we I _b-_.____Distance from foundation---1~fl____.--_ -.Materal _ rl Gci -�� ""_ ---- No Noof copartments Ca a--i. ----------- -- - -- --------- ---3KK__P_ ~_.Li uid dep ' t Disposal Field: Distance fom nearest weli__ C...__ _Distance from foundation___�Q-----------Distance to nearest lot line____S_-_------- Number of lines__._____ --------------- " Len th of each line----- "_. "_"----Width of french------ y- --------------- Type of filter material�._t_�? "i-C.-. � tK,of filter maferial--- ---- -""--Total length"___c___ $eepage Pit: � Distance t°O nearest well__ID.11_r__._____Distance from foundation...l._d---- __.Distance to nearest lot line___SJ-'_______ r a...x Number o! Pits-----_ ---------------Lining mafienal_�_ +1-� Mize Diameter :_ _..-_-__.__Depth--------___. --•------- Cesspool: Distance from nearest well-_____________^_Distance from foundation____-- _�'°::__.`i Lining material-_._"___--� -______-_.____. + ❑ Size: E3iameter------------------------ -------------Depth--------------- -------- `"'�---�=" Liquid. Capacity -----=-` gals. ea Privy: Distance from nearest .-Distancewell------___-_"______________________.__.;_--�- from nearest buildingI I� _ ❑ Distance to nearest lot line--------------'------------- ... 1M - ", Remodeling and/or repairing (describe): l --------•- -----•---•--------•------------••- ------------------•---••------ I �,..�,.....v��. II I�, -----------•---"----------------------------•-•--------- .------ s ________________________________________________________________"_________---.-._________-.______---..__________.___ II # t t -----------------------------------------•-•--•--------- --------------------------------••--------:----- --------------- --- I hereby certify that I have prepared this application and that the•work will be done;in accordance with San Joaquin County ccs ate laws, and rues and regulations of the San Joaquin Local Health District. I ' ---- -- -------------- -------------------------------------------------------------- ----{Owner and/or Contractor] -- ----- -- y (Title). -' ' - ---------------- ------ - --- -- --- ----- ---------- -- - - - - - (Plot plan, showing size of lot,kiocation of system i relation to wells, buildings, etc., can be placed on reverse side).: OR DEPARTMENT USE ONLY If APPLICATION ACCEPTED BY ------------- --- ------------- ------------------------------------------ DATE-. = � �'..._ REVIEWED BYN - -------------- -------------------- DATE------._ _._ �'= BUILDING PERMIT ISSUED. hM`------------------------`-- • - ----------'------------•---._ DATE------------- ------ =. - --- II Alterations �f andr/or _ . - - -- ti -_Lecommendo __- __:. _. _-- -- -------------- ------------------------------- -- y II ----------- -"-------------------•-----------•---------Hl_..------------• ------- FINAL INSPECTION BY:..--:-.. Rate----- 1 f S I SAN JOAQUIN LOCAL HEALTH DISTRICT E 134 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California II ES-9-2M 446446 ATWn"O IZ-54 I�