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�IAJ ,�i APPLICATION FOR SANITATION PERMIT Permit V f" �4�' No, _ (Complete in Duplicate) Date Issued _ Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h This application is made in corn fiance with County Ordinanc No. 549, ��S � � �,� erein described. JOB ADDRESS A LOCATION__ _:_j �� (A Vx&�0 Owner` # �=� h4 �_ ,� a �.-�+ ��jj II Owner's Name 4 f d - `�--�.---IZ®i��fl-5fOwe - ...................................................... Phone � �,� dress-------------•--------•--��.-- --"- � -----►� ki Contractor's Name we- - ------•----- Installation will serve: Residence - ------ Phon Apartment House ❑ Commercial Number of living units: _�"___" Number of bedrooms ❑ Trailer Court ❑ Motel [❑ Other ❑ Num; Depth of aths �� Water Supply; Public system -� Lot size Y ❑ Number system �Ct------------- Y Y ❑ Private to Water Table -------- ft. Character of soil to a depth of 3 feet: •,Sand Previous A lication Made: Yes Gravel [f Sandy Loam ❑ Clay Loam PP Y ❑ Clay ❑ Adobe �Hardpan ❑ ❑ No New Construct ion: yes r o ❑ FHA/VA: Yes [) No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if publi sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-_ J -.__Distance from foundation �; ' No. of compartments__ o� Material___-""." _" __-_.Size_ sr Disposal Field: Distance from nearest well f 4101 m, "� _Liquid depth__. " '_ _____ __ Capacifiy" "yu ,.� ��jj,�,, u�staOe om oi]nd�fion_---_/- / � Number of lines__ ----.Distance to nearest lot lin"�_'_ ----- - --- Length of each line--��_6 _�? In/idth of trench----saZ_ Type of filter mate aLo-�-----pepth of filter material____. m I "" -�"--" ---- -------- l Seepage Pit: Distance to nearest well__--_---------------- ----Total length_____ Q---P - / Distance from foundation___------ _-------- __Distance to nearest lot line_ ❑ Number of pits----------------------Lining material--:"_--- Cess Cesspool: -------------_Size:,Diameter------------------------P Distance from nearest well-----------------Distance from foundation.---"-___- Depth"-- \ • ❑ Size: Diameter___-___ __ ___ --- -- --Lining material__"- -------------------- ----------------------------------------- ___.___ -- -- -- ----- �----Depth----.---- ----- ------ ----- ----- - -- -- -- - --- ----- ------ Priv r t Liquid Capacity"--_ ""____ (� Y= Distance from nearest well.------------___-- ---_""- - ---------gats. ------------------Distance from nearest building El Distance to nearest lot line__-.__-________ Remodeling an ---------------------------- d/or repairing (describe):"-------- -------------- ---------------- ------------ ---------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regal tions of the San Joaquin Local Health District. Y (Signed)_ n LA_ -------- By: r C ntract ) , ---•-------------- ------ -- ---- ---- ° or (Plot plan, showing size of lot, location of system in relatio wails, buildings, tc., can((Title) placed on reverse side).) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ------ ----------------------REVIEWED BY DATE_ -------•----- ------------------ --- --- -- - •— ------------ -- ILDING PERMIT ISSUED- - DATE --- -------------------------------------- Alterations and/or recommendations: -------- -------------- DATE_•--"_ _ (fit-------------------------- -----I-------------- ------------------------ - --- - -------------- FINAL INSPECTION BYA,_�-).A41-- 14,4""-" 6LSOI ____ - Date__. -----1-'1 -1^--�-�--�-- ------=--=--- ------ 130 South American Street ------ SAN JOAQUIN LOCAL HEALTH DISTRICT ' 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California 8f4 North "C" Street Manteca, California Tracy, California ES-9-2M , Revisea 1-57 F RCO.