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APPLICATION FOR SANITATION PERMIT }"% Permit No. .-. - _-�_.___ (Complete in Duplicate) 71 Date Issued ----------- Applica'-ion 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. 544. JOB ADDRESS AND LOCATION-----�-p---.-aRLi--._cR_llL. -G?---ra, -+ Owner's Name--------R,...).---!•----•--... ------•---•----------------------------------------- ------------------ Phone------------------------------------ Address.-------..-.1.7_2_2 --------------- ` Contractor's Name -- -�- ..... --------- - • ------------------------------------------ ------------ Phone----••--••------------------------- Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f--__ Number of bedrooms _3___ Number of baths ---/--- Lot size --- _ _ _.. -- -,of ______________________._ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑. Sandy Loam ElClay Loam ElClay E] Adobe,E],,Hardpan E]Previous Application Made: -Yes ❑ No W1. New Construction: Yes g_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e 1 Septic Tank:, Distance from nearest well__ O_--__Distance from foundation-----/_Q--------Material-----C.G- No. of compartments----------s� ---Size------SZ-,'C-..A-Liquid depth----.--- --------Capacity------��--_-- Disposal Field: Distance from nearest well____:,�j��.._Distance from foundation.__ ,�7_ _...Distance to nearest lot line__oQ_�__. Number of lir ------- Length of each line-�_X.2D.Y,,2-1Xof trench----- ---._ f i [ f Type of filter material---/--3-----�.�Depth of filter material----_ ___ _________Total length--------_ _____.._.______.. Seepage Pit: Distance to nearest well--62-4-------Distance from foundation_.....Ic_ __.__.Distance to nearest lot line____ f0• / r Number of pits material__42'a._�/-Size: Diameter--.v?-S-17---- lJ� 1Depth-..-.dry.__- ----------- p Cesspool: Distance from nearest well-----------------Distance from foundation-----_--------------Lining material-------.___--_._-_____-.__--____-.-- ❑ Size: Diameter------ ---------- -------- ----------Depth----------------------------- ---------------Liquid Capacity----------------------------gals. � Privy: Distance from nearest well---_-----------------------------------------_____Distance from nearest building-------------------------_---------------. ❑ Distance fo nearest lot line--------------------------------- --------------•---------------••------------ { 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,rSfws, and rules and regulations of the San Joaquin Local Health District. • n (Signed)•-- -� - ---w--' ------------------ -------------------------- -----------------------((OOJ.wner and/or Contractor) BY: - ��. (Title) ---=------------ ----- (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 APPLICATION ACCEPTED BY----------------- DATE-----------•-- lJ� - REVIEWEDBY------------------------------------- ------- ----------------------------- --------------------------------- DATE----- -------- - �� BUILDING PERMIT ISSUED.---------------------- 4 ----------------------------•-------------- DATE ------------------------------------------- Alterations v Alterations and/or recommendations:-- ------------------- ------------------------------------•-------------------------------- ti1 ---------��a3,� -------- --------- 7 -------- 4�/�..-------...�.- w-----Z.«1_�------QL.�_6----------------•-• r. -------------------------------- � CJf *Y_� �r.....0 =..arT fL.0 E� `' ii'!_Pl7l ��'------------------- `- ----•--------•----•----6. pe-4.2`!r4- ......oe<4-----------A 14,AV-flj----------- ----------------------------------=-------------------------- FINAL INSPECTION BY----------------------- ------------------ Date--- -------- ------ ---- -_14-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 nTw000 iz-s<