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u APPLICATION FOR SANITATION PERMIT Permit No. .(Complete in Duplicate) � Date Issued __- Applical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. IS � _ 070 _3S ,j� r JOB ADDRESS AND LOCATION.. -- --------- Owner's �`� .� - 5' 1 ° Y -- ----------------- _.p-�``-----�_D. .---- ................ ....-------------------------- -------- ----------- ------- ----- Phone------------------.----------------- Address.................. k` h `t—� caner s ame______ �y ------•----------------- M t ,- ----------------•••--•- Contractor s �Name�'____J -O . _ _�.:_�_.�"J=_�__E.F-s_ ► �„ ---10— - -------------- Phone-•--------------------------------- Installation will serve: Residence finenf House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ Other ❑ Number-bf living units: :______ Number of bedrooms _y`_ Num0'6f baths .1_____.Lot size -" -3..__ __1_�' - r� .Tr• !�. ------ xWate` r S pply:,Public sysl�em-❑.,Community system ❑' Private� .Depth to Water Table ________ ft. Character of soil to a depth of 3 feet::" Sand ❑ Gravel ❑ Sandy Loam 0` Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made. Yes ❑ No❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic',tank or cesspool permitted if public sewer is available within 200 feet.) I IM c^� , Septic Tank: D°stanee from nearest well_-;cl.L�__.___Distance from foundation---�_Q___._.___.Ma erial___f?-�___.._�Y1_UC------------- t " No. of compartments..... ------------------Size--1-X�-X------------Liquid depth-----� ------------Capacity--50.0------------ Disposal Field: °Distanc1e from nearest well__�_-�}------Distance from foundation__116------------Distance to nearest lot line---15__________ Number of lines-_----7�------------------ --Length of each line---:2 ---.-------------.Width of trench. _- ----------------- Type,oi filter matenal_At_�J_.' __R11'1Qk� of filter material.._1_9__...____________Total length___._$__ _____________. ._----____.._ 1 Seepage Pit: Distance to nearest -------Distance from foundation---1__d__j_.____...Distance to nearest lot line.- - -_______ k Number of pits------./- -- ---- Lining material_e_Q----i _ ,_'GJk/e Diame __ ......Depth--. r ter 1M' Cesspool: 'Distance from nearest well-----------------Distance from foundation--------------------Lining material-_..__..________-_.____._.___.-.-- ❑ 14sjze: Diameter---- - -------------------------- ----Depth--------------------- --- - - -----------------Liquid Capacity----------------- gals. Privy: Distance from nearest well __.___.--------- ----- _ _ _____________Distance from nearest buildin ❑ Distan e to nearest lot line t Remodeling and/or re airi (describe :-- _ -'--- -- - - /-c1-(7.-��_Y."'.....,�__I� _�_�.A`�..�- --'�---�J�("----------------------------•---�-�-�}.i IM ---------------------------------------------------------------------------------=---------------------------------------------------------------------------------------- s I hereby certify that I have prepared this application and'that the work will be done in accordance with San Joaquin County ordi Stat laws, and rules and regulations of the San Joaquin Local Health:District. [Sig ----------------------------- 2G.w --------[Owner and/or Contractor) Y -----• --------- -------------- - - t d -----------------------(Title)------------- -------------------------------- ----------------- (Piot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). ttk. .,. #. FOR DEPARTMENT USE ONLY 0 APPLICATION ACCEPTED BY------ -------------- ------------ - --= ------------------ - --- ------ DATE------- - •--- ------------ REVIEWEDBY--------------------M------------------------------------ ---- ------- ---------------------------------------------------- DATE--- ----ice ! BUILDING PERMIT ISSUED--------------------------------- ----- ------------------------------ DATE-------------- . -*v--------------- Alterations and/or recommendations - --- ..... - -----f-------------------------------------------------------- V - ------------------------ I' lI. IN -----------------------•---•---------------- ----------- - ------------------ ------------------ -------------------------------------- - FINAL INSPECTION BY._-- -- ----- - ---- Date_..:-- --- ..4 6 r �. 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 E5—%-2M 145446 ATWOnD 121luy$4 ' '1