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�� e6 APPLICATION FOR SANITATION PERMIT Per No. ____________ _______ (Complete in Duplicate) Date Issued it Applica4ion is hereby mads to the San Joaquin Local Health District for a permit to construct and install the work herein described) This application is made incompliance with County Ordinance No. 549 +;,41,J: 2Z7 JOB ADDRESS AND LOCATION.......t.—e C« j .._= - �� - °jC-� . ------- -- Owner's Name-----------------•--''------fh l__R,,.--- _'--4-- ------------------ - - - ------- -------------- ------------- Phone---------•--------------•--------- Address. 4.r � Contractor's Name.. !.. .�4t^--- - `4 Phone r Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unlit s: 4____ Number of bedrooms Number of baths _Z___ Lot size -------- ------------------- Water Supply: Public system ❑ Community system ❑ Private g], to Water Table e _ ft. Character of soil to a depth_of-3-feet:—Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Mad : Yes ❑ No (i New Construction: Yes_ El TYPE OF INSTALLATION,kND SPECIFICATIONS: _ A (No septic tank or cesspool permitted jf.public sewer is available.within 200 feet.)-. Septic Tank: Distan�'e from nearest well- :____Distance fro undation__ D_____-_._.M terial--. __f _�_�_ __--_- No. of� compartments.- ___Size-.-_ _ __ Liquid depth..... Capacity_____ to G�1 Disposal Field: Distance from nearest we€I..... �.,.-Distance from foundation_-)O-------------Distance to nearest lot line---- _ �- 4I' Numb`: or lines_____________ _____ ____Length of each line------ -�]_____`?.____-_.Width of french------s�_ _,_____-_-__-.________ Type orifilter material` _-' t#-t. _Depth of filter material_____ _--______-Total length___________�&--------------------- T �t 1 01 Seepage Pit: Distance to nearest well-l&-Q----------- --____--Distance ftom for ndation`:3�_______ Distance to nearest lot gine___ Number of pits------2-_-------Lining material--- - Size: &kwrief'L-r_d�-_X_j-----------Depth---/ -----------_ �� i ------------ Cess ool:... Distance from nearest well _-------------D sfancerfrQA'm_Iounaati6n,��,,_,_�___.Lining materia --_________ _________________ ❑ Size: Diameter -------- -------Depth ----- ---------------------Liquid Capacity---_---•-------`------------gals. -Priv Distance from nearest well----------------_--___----_------_.El _..____-_--,Distance from nearest building------------------------------------------ Distance to nearest lot {ire:.'"-_"`•,^_- �------------------ ------•-----•-•-----------•--------------------•------- Remodeling and/or repai�r�ing {describe): --------------------------------------- ----.------------___-------------- -------- ----------------------------••-----------_-_-------- �11 ------------------------ -------------•---------------------------------------------- ---------------------------------------------------------------------•--------------------------------------------- --- -------------------- ---=-----------------• ------------------------------------------------------------------------------------------------------------------------------ hereby certify that I hZve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r k -_ . = =." ------------ (Signed)____-- �. (Omer a�%or.Cantr�actorl_ i Mpg —"w- 'w L�. ...;. (Title}--------- --------------------------------------------- -be .. --------- - -- (Plot plan, showing size ofiilot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR EP RTMENT US NLY APPLICATION ACCEPTED BY -- ---- ---- ATE ` — :/ REVIEWEDBY-------------- ------------ ------- ------------------------------------------ ------------------------- -- DATE------------------------------------------------------------ BUILDING PERMIT-ISSUED-------- ----------- ---------------------- -------------------- -----: DATE - Alterations and/or recommendations------- - ---------------------- -- --------------------- ---------------------------=-------------------------------------------------------------------- :. Ii ------------------------------------------- ---- ----------------------- F•-----------•--------•--•---•---•-------------------- ... 1-1 ------•-------- ------ ------------------------------ ----- --------------------••-------••-•---------------•--••-------------- -----•----•----------- - ----------- ----------------r...-- ----------------------- _------ - i --- - ---t FINAL 'INSPECTION BY:.. ---------------------- Date-------- ' .._ . 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 ATWOO❑ 12.54