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= APPLICATION FOR SANITATION PERMIT Permit No. . : (Complete in Duplicate) Date Issued --- _3$/S 757 Applica+ion 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. 5 JOB ADDRESS AND LOCATION---- - -----------t`,J U -" Owner's Name... _._. . .-- --------------------------- ------------------------------- Phone------------------------------------ Address--------- ... ------------------------- Contractor's --------------- ------ _ Contractor's Name � � _`LJ 7. C��l_-�a�..------------------------------- Phone--�, Installation will serve: Residence 19 &partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms _-) -.Number of baths __r_._ Lot size ___4��_--_� �._�-,-4_ --------- Wafer Supply: Public system 9--90mmunity system ❑ Private ❑ Depth to Water Table,5.41_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adober pan ❑ Previous Application Made: Yes ❑ No j�New Construction: Yes 6-1q-0-13 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel � -___Distance from foundation__. __- - ---- -- ---------- p � ---.Material_`�- lJo. of compartments------- _---------:Size_ ` ---Liquid depth.... - ----------Capacity.._Z�5, 7---- �' f Disposal Field: Distance from nearest well _Distance from foundation___. Distance to nearest lot line.___ Number of lines-- --------- --- Length of each line.____j. _. . ' Width of trench._____ -_ _`__�______________ . -_-__--�;;__... E Type of filter material.__.�__ "_Mepth of filter material.____ length_______,3d_________________________ Seepage Pit: Distance to nearest eller- ._____Distance r m fou ation__�[�___�.Distance to nearest lot ii�ne__ n�:--__ Number of pits______ ____ ____Lining material-- Size: Diamefer__3231- _-...___Depth-2-&___ _ ____... _____ Cesspool: Distance from nearest well_________________Distance from foundation..----------------- Lining material_______,,____.______-____________-- \ _❑ Size: Diameter------.� ------ ------------------Depth------------------- -------------- ------ ------Liquid Capacity- -------------------------gals. Q Privy: Distance from nearest•well__________________`'____°-____. r ._._."._Distance from nearest building_ -------------- ---------.--------------- X 171 �1' i 1 Distance to nearest lot,line- =' M �.Vl -------------------------------------------------- Remodeling and/or repairing (describe):--------- ------------------------ ------ ---- :--------------------------------_-----------------------------•--- ---•--------- , ------------------------------------------------------------- ------------------------ .........----------------------------------------------------------------•--------------------------------- ------------------------- ---------------------------•-------•--------------------------------------------------------------------------------------------------------------------------•--••-------------------------------- I hereby certify that I have prepared this applica+ion en'd thaf'+he work will be done'in accordance with San Joaquin County ordinances, 54te laws, and r es and regulations of the San Joaquin Local Health District. (Signed) -- ----- ------------------- - -------- ,t'...� ----------------------------------- ------------------ r Contractor) s • ' - - . : Title �� (Plot plan, showing size of lot, location of system in relation to ---------------------------------------wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ---------------------•----------------------------------- DATE---- J REVIEWED BY------------------------------------------- \_ -------------------------------- ------------------------- DATE-- ----�- BUILDING PERMIT ISSUED-------------------------- -------------------------------------------------------- DATE--- ---- ------ Alterations = Alterations and/or recommend a+ions_--------- ` :---_•--_.-_- ------------------------•-----•-------•-----•------------------------ - -------------------------------------• - .-•-------------------- -.....-------•--• -----4--------------••---••--------- NQT,__ QR._,F.$.A.------------------------------------------------------- ---------------•-•--•- ------------- -----------------------•- --------------------------------------- -------- ----------- --------------------------------- ---....---- ••----------------------.._...-----------•-------------------------- FINAL INSPECTION BY: ----- It � ------------------------ Date------- _.._1--- Q- ��—S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C• Street Stockton, California Lodi, California Manteca, California Tracy, California ES-�9-2M 145446 ATwa Do I2-5r