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APPLICATION FOR SANITATION PERMIT Permit No. ....7r..L.._.._ _ (Complete in Duplicate) Date Issued Applica-lion 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 r County Ordinance No. 549. : JOB ADDRESS AND LOCATION---- ---1--1-q------- ----------------------------------------------------------------------------------------- Owner's Name -� src►--- = ------------- Phone_5-.zS z------- # AddressSJ t1- ./C�,, ----------------✓-------------------------------------- ------------.---••--------------- ---------------------------•---••-----•-••--•--- Contractor's Name---------- i - / .�.G . �t/- ��' ' Phone� G Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,l_._ Number of bedrooms ,_7_._ Number of baths /__ Lot size __,�l1__ }!,� _-____________________________ Water Supply: Public system [G'-Community system ❑ Private ❑ Depth to Water Table ,l--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ , Previous Application Made: Yes ❑ No ff`� New Construction: Yes E?""Nlo ❑ 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 fou'dation__/¢_ .__ _._-Material---�`. .% �.- , _ No. of compartments------- --------------Size_„5,6-_-3CYl�_________.Liquid depth.--, ,1�'�-......----Capacity_. eA--- Disposal Field: Distance from nearest well �'✓__Distance from foundation___16-----------Dist arice to line..-_--____- ' Number of lines----------- Length of each line_��4_8�-_A _`Lr-.Width -- ------- ------------ Type of filter materiaLS*_fft_0_(- ._Depth of filter material----/if_11._....___Total n ! Seepage Pit: Distance to nearest well___------------------Distance from foundation--------------------Distan e nst{tat-I' --------___._ ❑ Number of pits----------------------Lining material_----------------------Size: Diameter---------------------- ----------------- -------------- Cesspool: Distance from nearest well________ ________Distance from foundation--------------------Lining material--------_---- ------- ----------- o : ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity_ -----------------------gals. N i Privy: Distance from nearest well---------------------------------;-------------.Distance from nearest building------------------------------------------ F1Distance to nearest lot line------------------------------ --------------------------------------------------------------------------------------------------------------- `I Remodeling and/or repairing (describe):---------------------- __ ------------f° ----------- --------------•...- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------•--------•---....-----------------------•---•--- -- -------------------------------•-- --------------------•----- ------------------•-------•--------------------------------- I hereby 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) � ` - 'i- -----------------_AF Own'?r and or Contractor _.R -- c. ,. I ------------------------- an, ----------------------- [Plot plan, showing size of lot, location of system in relaon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, C _' z- r- .-- a ,r APPLICATION ACCEPTED BY- -_,_-DATE- --------= ---- ----= a s REVIEWED BY-------- ----------------=--•---- ------------ --------------------- ---------------------------------------_ DATE__. �-------------------------------------------------- r ------ ------ DATE------- - x-----------------------------------•---------- BUILDING PERMIT ISSUED Alterations and/or recommendations:--------- pp------------------------------------------•-----_-_---_-_-_------------•-----------------•---- �a__�__---......--- -----------................... _ _-___ _________________________ -- - . . -------------------------------------------------------------- ---------------------- -----------------------------------------------------------------° -------------------------------------- ----------{ ` ` _ = ----------------------------------------- - ----------- F' % i f FINAL INSPECTION BY: -------------- ` `y�,_ Date ��r/47- -_ �j e SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 11L 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOOO 1Z-54 �? 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