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b - APPLICATION FOR SANITATION PERMIT Permit No. .-_ '.-9 -� (Complete in Duplicate) Date Issued -_ _' --- -- G Application 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. d q I............................................. - -------------------------------- � S 5 -- JOB ADDRESS AND LOCATION�3--------------------- ------- �/ ----- -------------- ------------- Phone------------------------------------ Owner's Name------_�_�___'_---��---�--------I/__-�--�.�_�'/P_.i!__ ------------ -------- ----- -- ----- Address------•-------- �---------------------------^----------------- -----------•------ 3 Phone-----------------------•-- - . Contractor's Name----- •---��-'�--•-- - ---- -- - ---- •- - --`---------------- ----- --- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Lw- alt 5 �9C�.c-'f ------------------------•- Number of living units: � - Number of bedrooms-3-.- Number of baths -_ Lot size ------------------ -_ Water Supply: Public system 911�community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe M__T`Iardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes 1A 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 wel4_________________Distance from foundation------------------- lSt�n� No. bf compartments------ - -- --------- -Size-------•------------------------Liquid depth--------- ----------------Capacity.. DisposalFieldr Distance from nearest well---------__----_Distance from foundation.__________________Distance to nearest lot line----------------- ❑ 01 f 1 j Number of lines-----------------------------------Length of each line------------------ ----------.Width of trench-- ------------------------------- Type of filter material-------------------------Depth of filter materia4----.--------------r Total length------------------------------------------ rest ` Q Distan�e to nearest lot line!_.lr Seepa Pit: Distance to nearest well./ O_f1� .-Distance from foundation__-., _---_----- 3 Deptn-___.. - .'--- ----,f l9 Number of pits..--.___l-----------Lining mate Size: Diameter------ C` Cesspool: Distance from nearest well----------------- from foundation__--_--_---_--.__..Lining material---- ----------------------- als. ❑ Liquid Capacity---------------------------- f Size: Diameter---- ---------- ----- --- -----Depth-------------------------------- ---------- -- -- -9-----. 1i1� Privy: Distance from nearest well-------------------:----------------------------Distance from nearest building--------------------------------- n ❑ Distance to nearest lot line-- ---------- --------------- --------------------•-----•-----•------------------------------------------------------------------------- h 6 cl f �-° -------------------------------------------------------- 4 Remodeling and/or repairing [describe]_______________________ ! � --•--- � ` --•-----------------------••----- -------••--------•-------------•----------•-----------------------------------------•------•--------------------•------------------------------------------- ------------ ---------------------•----------- ------------ --------------------------------------•-------•--------------------•-------------•----------------------------------------------------- --- --------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a s, and rules and regulations of the San Joaquin Local Health District. Cf ( ner and/or Cogtra.cfo�] (Signed)---- -- /'S ------ ' ----•-(Title)----- By:...---- ------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ��L��shy APPLICATION ACCEPTED BY --------------- -------- ------------------------------ DATL.+et^� --------------------------------------------------- REVIEWED BY - DATE =�:� DATE BUILDINGPERMIT ISSUED------------------------------------- --------------------------------------------•- --------- 4^7 Alterations and/or recommendations------------------------- ---------- -------------------•------•-----------'-_ - --- --------------------- ------------------------/-------- ------ ---- ------------------------- ----------------- --- --------------------------- - FINAL INSPECTION BY:.------.-.-ov •-=---- Y - Date: .. "] --------- ------------------------- _ f, ' SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 134 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y1 EE--9 145446 ATw000