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ka V APPLICATION FOR SANITATION PERMIT Permit No._- Q y< :, -{Cornplefe in Duplicate) Date Issued - �- ,*Ap application ion is a made to the San Joaquin Local Health District for a permit to construct and in This application is made in compliance with Joaquin Lo Ordinance No. 549, stall the work herein described. r JOB ADDRESS AND LOCATIONk 21.4 .___ .. Owner's Name. ` ! _ ____ a ___________ _____________.._-_._.-__-___-. Address-----------------------•-- � ----- ------- ---- -------- Phone ,�J� r •----•--- F/'� ,G � 116/----- ' Contractor's Name.--- ------------------- -el------------------- Installation -----•--- ----- Installafion will serve: Residence Phone [!3,Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms -R_-_ Number of baths .�____ Lot size ___. - r Water Supply: Public.system Communi} system �`1 ------------ Y Y Private ❑ Depth to Water Table _ Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Previous Application Made: Yes ❑ No ❑ Clay ❑ Adobe 'Hardpan ❑ w ' New Construction: Yes [� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank.or cesspool permitted if public sewer-is available within 200 feet.) 4 "�° s Septic Tank: Distance from nearest w` IA/4*4 Distanc�ronn foundation_.__ ___ No_ of compartments_____ - � ---•----.Mae ria--e--�- Size_ ''// --- ---------- ',� ��-`7- Liquid depfih_I -� Capacity Disposal Field: Distance from nearest welt_ "'Distance from foundafiion__t _Q....- f r P P Y - '57 __._..Distance to nearest f?t line__- Number of lines__.-____�--_-_ Length of each line___ - _-_ �` •� �� * ------ ----------Width of trench Type of filter material_ _ ¢Depth of filter material..-.49 - Total length------ Seepage Pit: Distance to nearest well_. ------------------ j,�> j61)istance from found ion_._._ --- •� Q- --..Dist nce to nearest lot line__ _ (� Number of pits- ---�------------- ` � - 1 Lining material-t�+�`--&I-- ¢e: Diameter_-- �i Cesspool: Distance from nearest well_____________ - Depth e' sem----- ___Distance from foundation------------------- material------------------------- ❑ Size: Diamefier--------------------- Depth ---------------------- - ------Liquid Capacity.. � - - ---- -- Y' Distance from nearest tivell_--_-_-_---,_--_-- gals. ---- -------------- from nearest'buildin ❑ Distance to nearest lot line------ ---------- g.---------------------------------------- ---- __--____--_-_-------_ - _---• -•-----•---------------•---------•------------------•-•------ Remodeling and/or repairing (describe):---------- - ------ --------------------- - IC- -•------- •------•------•--- ----- ------------------- -•--------- ----------•-------------------•---- U --------------- ------ e eby certify that I have 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. �'• (Signed) -•-------•---------- '1471-�-fir- •--- �-- ------- ��-��_- .------ -��--.fit - a •------------ ------{ By:---.. - Owl -- •- - -•---- �`�1,�v -- - •- , ,Con}ractor] a (Plot plan, showing size of lot, afion of system in relation fa wells b ' (Tifle]__' � rs�� F uildings, etc., can be ------------- - laced -•` p on rever side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _-_ - REVIEWED BY-------------------------------- ------------------------ ----------------•--------- ---------------- DATE.—`---k BUILDING ; ----- ---- -•-- --- ------ --------- ----•----------------•-----•---- DILDING PERMIT1SSUED--------------•_--.---___-- DATE---�- Alterations and/or recommend*--ions:----------------------------------------•- � DATE. ----------- ------- --------- - ------ ` --------- ------------------ -------- ---- ----•---------------------------------- ----- f ------------------- ------ I------ -------- --------- ---------------- ----------------y- ------------*---------------------------------------------------------------------- FINAL INSPECTION BY:.----- �.S_ Jc' -Date- .. 130 South American Street ---- S SAN JOAQUIN'LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California 814 Mcrf6 "Cl.- Street Manteca, California Tracy, California ES-•-g � 145446 4TWOpO 4