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Is ►, s Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date -Issued Application is hereby made to the San Joaquin Local!Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- .SZ21------ r ----------- c r'•�- r Owner's Name. 5 . ----•-----•-�.------_ -l _ -1-- PhoneQ Address.................... . -------------�'------ 4U/2/6 r�c--------- k�eA--------------------------------------------------- Contractor's Name---- -r--- .1----.....�__ 1 ( s�7%IL1f ----- A_ ----------------- Phone +�Q ii Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ° Number of living units:^4-Number of bedro�'ms .;__-'Number of baths _1---_ Lot size _--- ----_- Water Supply: Public system '1'U/ Community system fl Private ❑ Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gr0 vel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No D New fCi onstruction: eYes 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__N0f P__Distance from foundation--/O----------.Material--- KNo. of compartments---� Q.-is-----SizeSA_=UV_` IL-Liquid depth-_J_'A1-------------Capacity._2O_t1---4:�F: Disposal Field: Distance from nearest wellLf�Ce�( '.-.-.Distance from foundation-------------Distance to nearest lot line___.-------ry i Number of lines--- �� r.. -_-Length of each line_-o 5 `_------------ 1) r -_Width of trench_�-�_"_..___-_._-_-_--._-_ f Type of filter material_-IQ�C Depth .o er-rn t ial__/_�--------------Total length----_----.3..�_---_-----------_-._-- Seepa e Pit: Distance to nearest welLfk9�1+ .'-_D ante from foundatl `!'`-___.Distan�e to nearest lot line �.---_ Number of pits_ _ed_Lining aterial__ 9-1-�/�-Size: Diameter---- . _--__--Depth_- _0-------------------- k jjj��"' ,� Cesspool: Distance from nearest well----------'�----_ istance from founda n--------------------Lining material-----------------------------.---_-__ ❑ Size: Diameter-------------------------------------De ------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------ ------------------------------------Distance from nearest building_--_-----_--_---__-__--__-_-_--_-___- F ❑ Distance to nearest lot line---------- ------------------------------------ ----------------------------------------------------------------. ---------------y Remodeling and/or repairing (describe):----_-_ ._-_.____-Z �.--.___..-- s✓l ..-. ------------------- ---•-•--------------•-•-------------------------- ------------------------------------------------------------- ► ---•-•--•---.. i ------- -------- ----•--------------•------------------------------------•------------_------------------- --------------•------------------------------------------. -----------------------� ••--•----•--------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, an rules aKi ,fregulations of the San Joaquin-Lwal Health District. (Signed)..._..... ------- - =` ---- - --------- ---- =-- --- '-"' Z , (Owner and/ r'Can+ra If i I • --------- �� ------ e ---- /J4 ,- Ti+le- h -° -•- Y' ( ) t. (Plot plan, showing size of lot, location of system in rela ion to wells, buildings, etc., can be place on reverse side). Il r. a FPR DMTMENT USE O Y APPLICATION ACCEPTED BY- -----Xe---= -------- DATE -------------- REVIEWEDBY-----------------------------------------------------------------=------------------------------------- --------------------- DATE--------- -------------- BUILDING PERMIT ISSUED `M---------------- DATE ---------------- r_ -----_ h Alterations and/or recommendations--------------------------- •'-------------------------------------------------------------------•---------------------------•----------------------•- -----------------------------•----------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- __••_-_•__-•-------------.__•----.------._.--.----------•-------------------`--`------_. _---- -------------------._----------------_---._-.._•_.--_----_-------------------------_------------------------ A li FINAL INSPECTION BY: =------ Date-------------- -`` . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stre+- 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California .. Lodi, Californiia Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 1 1•+ H . -