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P-*" -- 1.1 APPLICATION FOR SANITATION PERMIT Permit No. (complete in Duplicate) Date Issued Applica4-ton 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 Count Ordinance No. 549. j JOB ADDRESS AN ATION_ - ----- -4f --- - -- - ---- -------- ---------- ?* Phone------------------------------------- Owner's Name------TZ___ W/, &17 Address---•------------------Z0z____,4_AD1V--------IS-47 - -- - -- ----------- ................-5,4N------- --- - - -- -------------- _Y47f 97 ------------------------------------------------- Contractor's Name__.-----1----- -------16M,----------------------------- Phone Installation will serve: Residence ❑ Apartment House 0 Commercial 0 Trailer Court 1:1 Motel 0 Other Zk?lVZr_1.t1%V� Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------ Water Supply:- Public system El Community system El Private%, Depth to Wafer Table SY ft. Character of soil to a depth of 3 feet: Sand 0 Gravel [I Sandy Loam 0 Clay Loam Ej Clay E-] Adobe iv Hardpan 0 Previous Application Made: Yes 0 No K New Construction: Yes E] 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- __-.-._ Distance from foundation------------ -------Material------------------------------------------------- E]QX1Sr1AC_- No. of compartments----------------- - ..Size--- ••------------ Liquid depth--------- ----- ........Capacity...-------------------- Disposal apacity...-------------------- Disposal Field: Distance from nearest well-----r�==r distance from Lfoundafion-------.............Distance to nearest lot line----------------- line-----------------------------Width of trench.----------------------------___.-- ;'X I S'jl�IVC7� Number o' lines------------------- -- -- Length of each line El L Type of filter material-"........ --------------Depth of,filter material----------------------Total length__-.--------.__-------------___---.__.--. r - Seepage Pit: Distance to nearest well .1;15W,-Distance from foundation.....7- ------ D,15 qpce to nearest lot Number of pits.._;Z-------------Lirf�i`ng material-B Diameter.— p Rld-/<,._Size: Diam - -- - --------De f'n--.;?,,S--------------------- Cesspool: Distance from nearest well-_--_.--.-- Distance from founclation_ ---------------Lining material--------------------------------_-._. . Diameter_, -------------- Privy: Distance from nearest well.---..--- ------------------- I----------------Distance from nearest building----------------------------------------- - --------------- _------------- Distance to nearest lot line.:........... -------------------------oe---------------_ --------------------- Remodeling and/of repairing (describe]:------- ----------- ----------------------------------------------------- -------- ----- ----------- .... ------------------------------ ------------------------------ ----------------- --------------------------------------------------------------------- --- ------------------------------------------------------------------ ---- - --------------------------------------------------------------------------------- ---------------------------------------------------------- I hereby certify that I hey ared this application and-that the-work will be done in accordance with San Joaquin-County ly ordinances, State laws, and r les an regulations o6the San Joaquin Local Health District. ------- - -- Contractor) ifl------- -------1------ ---------------------------- (Owner andj4t (Signed)--------------------- --- -------•--- ----------- t----- -------- --- --------(Te)- ------------------ By:_----------------_ ---- ---- --- ---- ---- -- ---- (Plot plan, showing size Xot, location of systemi relation to(jells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY ----------_-------------------------------- APPLICATION ACCEPTED 13��4_ - -------------------------------- -------- -- ---------------------------------------- DA1 REVIEWED BY---------------------------- --------------------------------- ------------------------------------ DATE_3��------------------------------I------------------ -------------- BUILDINGPERMIT ISSUED-- •---------------------------------------------- ----------------------------------------------- DATE--------VN------------------------ ------------------ Alterations and/or recommendations:------------ -- ------V------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------I----------------------------------------------- ----------------------------------------I----------------------------------------I------------------------------------------------------ -------------------I------------------------------------ ---------------- "------------- "-----------------------------------------------------------------------------------I------ -------------------------- ---------------------------------------- ----------------------------------------------- ----1------ ------------------- -------------------------------------------------- --------------- ------------------ --- 0 ----------------------------------------- ------------------------------I------------ ---------------- --_------------_----------------- - ------------------------------------------------ - --------------------- FINAL INSPECTION BY-- ---------------------C;Z --------------------- Date.... ....... - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfraet Stockton, California Lodi, California Manteca, California Tracy, California Es_9_2M 145446 ATWQGD 12-4