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o l7U 7/ ii APPLICATION FOR SANITATION PERMIT Permit No. ___L_.! - /,._•_ (Complete in Duplicate) Date Issued This a a+ion,ca is is made i to the San Joaquin Local 'Health DiOricf for.a'permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.: JOBIADDRESS AND'LOCATION _�.- _. --------r-----'----' Owner's Name--------= � ...._ = '` - - -- Phone- = Address --- I _ , -----.— i -- Contractor's Name.... _. 1 P --}•------=------- -------------- Phone - . .. Installation will-serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ` n� y 'Number of living units:'_(--____ Number of bedrooms 1_ : Number of baths :__ Lo# size ____:__ ❑ J, b Water SapplIF y:'"Public�syste�ri� Comm' sysfem�❑""NiJate ❑ ,Depfh to 1+Vater,Table"'___-- ft. 3 ' � Character of;.soil to a"depth of.3 feet Sand ❑ Gra;el ❑ Sandy Loam [I Clay Loam1. 1 . Clay b Adobe Hardpan E]Previous Application. Made: Yes ❑ N6*'� New Construction: Yes No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publics'wer is available within 200 feet.} Septic Tank: Distance-f"rom nearest well............._ Distance from foundation_______- __,-----Material___-___r__---_.----- . No. of compartments_ Size -------- ----------------Liquid depth = CapacitY Disposal"Field: - Distance from nearest-well----:----------- -Distance from'foundation----,-__ ___ _3_ -.Distance to nearest lot line----------------- m Number of lines----------- -- ---------------------!.Length of eachlline--- :------.Width of trench-------------------- . J R - pfh . _ ----- Tota! length TypeoT filter material______________ __ ____:_ De th of filter material_______ Seepage Pit:, Distance to nearest well . --_._-__-_-Distance from foundation___-_.___-..:__:__-..Distance to nearest lot line------- n, " Number of pits-----:.----------- Linmg material_-.__ ___.".- .f Size: Diameter--------- Size. Diameter_.__.; we Distance f rn foundation_] g � � � � _�__f__- ._.Linin material_ :- z spo Distance from near st - DePth ____ =- Liquid Capacity-.--,�q Priv z•!� � � ?€ - a ui ----------------------gals. y=. Distance r m nearest well.- .. ___...,--___ `----------------Distance from nearest building--------------- --------- ___ "-_ ------_- .�..._ ❑ Distance to nearest lot'lirie ".-.'.._"^.;� .... �+ -:.p w- -�.�.:,. .::.•. .: -•----------- --- ------- Remodeling - Remodeling and/or repairing (describe):------------------ ------------------------ I t.--{• ; I _-•__•___________ "_ q .____.___ ---------------------------------------- ----------------- E -----_---•------• ----------------------------------0--------------------- ---------------- - ' i - ---------t U f t s ------------------- -•- ___________________________________________________________________________________________________________________________________________�______- 1 hereby certify that-! have prepared this, application and that the work will'be`d.one in-accordance with San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed}_ -- .t,C .._ ` --- ------ i "° .l .� --------------- �------------ :.---------------------(Owner and/or Contractor) Plot Ian, showing size of lot�1 By�----- I y - Title ocat,on�of s stem in relation t ------•-------------•----- •- -.---- .----- ( P g o wells, buildings, .etc„ can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'-1: --------- ..._._ ----- REVIEWED r -- . -'-' -- - -- ------------------------------------------------ DATE-----' -•----•--- ----• ----- ----•-•-------------- - REVIEWED BY = ------------1�- t l�. . '' ----------- --------=--'---------- DATE---- �.�. BUILDING PERMIT ISSUED------a � -•-------------------- ------------ ----------------- DATE.__.-' ----------- ' - ------------------- Alterations and/or recommendations:_-�_________-------- -------------- _______ �_ ._. I E ------------- -- - t i-------• -------- --- - ----"---- = ---------- --------'-----•-------•-----------------•---•- •---------- ;... -------------------- ------ �- --• ---------------------------------- ---------- F - -- ---------------------------------------- 16 ----- FINAL 5lNSPECTION BY:. i_a.:�. `" --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES__-9_2M 145446 ATWQ90 IZ-54