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�.�„ ;Jr - _• ;.•,....,:tea::, f APPLICATION FOR SANITATION PERMIT � Permit No. .-- --_-�"-_ (Complete in licete) ` .. Application is her made to the San Joaquin Local Health District fora ermit Date Issued This a plication is 714 made in complian with County Ordinance No. 549. to construct and install the work herein described i ' " - - _ —�— !- 'J.�J�----'-.- -----9---- 0RVJOB ADDRESS ANDLOCATION_ ► u -Owner's Name Address ----------- A/41- s --------.. / ^ZT x �..,.� Phone Contractor's Name ` Installation will serve: Residence ------------------------------------------ f ------------------- ---------- Phone House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: .___ Number of bedrooms �-" _ ❑ Other ❑ Water Supply: Publics stem �j Number of baths /" Lot size __-✓ /� Y Community s stem --` ""---'--`�'------ - Y Y ❑ private ❑ Depth to Water Table ___. ft. Character of soil to a depth of 3 fee}: Sand ElGravel I Previous Application Made: Yes ❑ Sandy Loam ❑ Clay Loam Clay El globe ❑ Hardpan ❑ �# Construction: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Septic Tank: Distance from nearesr well _ �d.YDistance from foundations-_ f ® No. of compartments_._-"_ - -- a -Material_._-;t��t_CY'-�e�,.� Size_/,D -- - -------------------------- - ---- ---- - --� � --�_----Liquid depth...... -- �--- Disposal Field: Distance from nearest well_..____."__ ---Distance from foundation-___ Capacity___ IQ�--__-.Distance to nearest lot line.,--- Number of lines___.____ _-" � ------- Type a Length of each line____--� _ ""--" Width of trench.___�X_-" yp or filter material___. D. _ _--Depth of filter material-__.__ _. �� /------ Seepage Pit: �{�- - ---"-_Total len th_-__---�r2�__ Distance to nearest well__________________ _ Distance from foundation________-"- g 4❑ l��urriber of pits---------------------- ---.-__..Distance to nearest lot line__-_-"- ----------Lining material------- Cess ool: Size: Diameter --------------Depth__------ ❑P Distance from nearest well-----------------Distance from foundation-------------------- q Size: Diameter--,--"_-- ------.Linin material--- Privy: aterial--------------"---- . {. Die th---- ---- ----- - g a.r-,.a�.y --•------•-------_-=-• ----------=-----�.JsiquidrCapacity_:- —,..m r.y Privy: Distance from nearest well-------------------- Distance from nearest huildin El Distance to nearest lot line : g----"-----------"_-"-- O , --------------------=- - Remodeling and/or repairing (describe): - --------------- - 14, --------- f -------------------------------- -------------- ----------------------------- -----------------------------•-------------•------•----- are ---- ---------------------- - -- --------------- -------•-----------.------------ ! hereby certify that:! have prepared this application and that the work will be done in accordance with San Joaquin County $ (Signed)-•------•------------ --------------------------------------------------------- - ----------------•----------------------------------- •_ _ ---.(Owner and/or Contractor) �._- i (Plot plan, showing size of lot, location of system in relation to wefts, buildings. etc., can 'T g ' { p on reverse side). FO PART ENT USE NLY APPLICATION ACCEPTED BY_-"_-- REVIEWED BY-------------- DATE ----- BUILDING PERMIT ISSUED.=,.=�__:—'- -�- DATE Alterations and/or recommendations: L ie ---- -------------`-`SDA __---------- /1 •/rs� ji.^:'P '�r ------�lt.� -- --•--• --•-------•---•--------�,7-- -+-------- -_____________________________________________________________________________________________ __-_____ A _ -__--_.____--- ____i___.__.._-- -------------------------------------------- ---------------_-------------------------�_.._ FINAL INSPECTION BY------------------ -------- ---- - Date----- ------- ------ �-- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street E14 North "C" Street Lodi, California E5-4-2M 10-52 Revised W-2100 Manteca, California J� Tracy, California I f