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�Ill` APPLICATION FOR SANITATION PERMIT Permit IVa: :_`T:.d- — (Complete in Duplicate) Date Issued ._-•- Applica}ion is hereby made to theSan Joaquin Local Health District for a permit to construct and install the work herein described. This application 1s made to compliance with County Ordinance No. 549. - 1 �--_7_____.---- ------- -- ------------------------------------------------------------------ JOB ADDRESS AND LOCATION, ---- Owner's Name------ ._h__�.__ --.._ Phone--------------------------------•--- Address------.... II `�`` - - / Contractor's Name.---- .... AL1•--- - ----- -- ---- -- ---- -----:-------------------- ----_. Phone_I�`�r Gtr._ 7 r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f__!' Number of bedrooms ___ ' Number of baths .-_ Lot size _149-t-___________________ Water Supply: Public system 'Commun6. system ❑ Private ❑ Depth to Water Table 1.e- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 8—No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) / 1 Septic Tank: Distance from nearest wel 'h -Si'stance �from foundation__.Ie----_ ---------- - ---- _--Liquid depth__-M- ate�iaL_.-- ------Capacity.-.-.-_-_- 2------- No. of compartments------ Disposal -Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line-___-___--__._. f ❑ Number of lines----------------------------------Length of each line----------.------------------.Width of french---------------------------.----_-- Type of filter material-------------------------Depth of filter ma.feria----------------------- length____________________._____________._.._.._ Seepage Pit: Distance to nearest well__-L_Ve?:1.5�. Distance from .foungla i n___1�_.._.___.Distance tP nearest lot line__ 7 __-._ {dumber of pits...._/_____________Lining materia .�� Diameter._..��,.�___Depth-----. ... �________ Cesspool: Distance from'inearest well-----------------Distance from foundation--------------------Lining material______________________________________ V ❑ Size: Diameteri-------------------------------------Depth-:-------------------- ------------------:--- ------Liquid Capacity-.-------------------------gals. .___._.._Distance from nearest building---- ----------------------- ---- Privy: Distance from Inearest well__________________________„___. -: . _. - ----. ❑ Distance to nearest lot line----------------------`------•-----------------------------•-•- •------ ---------------------------------------------------------------------- Remodelingand/or repairing (describe]:---------------------- --- ----------- ------------------------------------------------------------------------------------------------------------------ .1' -------------------------•----------------------- ------••--•--------••-•----------------------- •--•----------•-•-------------------------------------------------------•------------•---------•-------•---------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, S e s, and rules and regulations of the San Joaquin Local Health District. [Signed) - - - -'fir -' [Owner and/or Contractor' Plot Ian, showing size of let, Iota - [Ti#ie)______-- _------------------------------- By: ( p 'tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ _. ._._ DAT ---- ------------------ ------------------------------------------- - -- -- - REVIEWEDBY---------- -- - - DATE--- ----------------------------••-•-------•------: BUILDINGPERMIT ISSUED.--------- - - ---------------- DATE_..--A---------------------------- ----------------------- s Alterations and/or.&-r r.ecomm”endations: "s , {1w� ._..rn. -------- --- ----------- - - ------� --- -------- --- ... - � �r--?._... I-- r r ___________________________________________ I-----------.__._.___..__.._._____.___..._-__S__.___.-_--_._______.._.----.-_.________.._.______-___________.__.__C____ .._.__._._...______..________________._..___.- FINAL INSPECTION BY:......_.__' x '01 ,� Date -/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ;I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California �� Lodi, California Manteca, California Tracy, California Es-s 145446 ATWOOP �;