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r \\, ... ail lipAPPLICATION FOR SANITATION PERMIT Permit No. . ..7.d....... } (Complete in Duplicate) �. Date Issued Applical-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. 549. JOB ADDRESS AND LOCATION----------- ----------------------------------- / Owner's Name------V`�¢'--`----r7 �---------------------•=-------•-=--------------- - --------------------------------------- Phone-Pv----4l. Address......_ r------ � Q"c' ' -----------------• ------------ ----------- Contractor's Name-----: `-------- •--•--- ---^------••-•---•--------------- ------------ Phone---- &a7-_7p-5'`�- Installation will serve: Residence-E] Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other - Namber of living units: _- '___ Number of bedrooms -Number o aths 14 Lot.size ____________ __rJ_ _ � _ �_�___.._..__,..__ Water Supply: ' Public:system :❑ Community systeri ;r ate . Depth to Water Table -------- ft: , Character of soil to a depth of 3 feet: Sand [ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application-Made: Yes ❑ No v*, New Construction: Yes 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 welE _ _Distance/ rom fo dation__: _ ..____.Material-_________________ _____________ No. of compartments....` --------------Size_�7--------- -___X--Liquid depth--- A------------Capacity_. __----- 44 10 / ' ,` / Disposal ield: Distance from nearest well._,1 .__...Distance from foundatlon__/SG__..___-.Distance to nearest lot line of lines---- Length of each line_.?7V.__._- Width of trench---vk_T......-_............ __ Type of filter materia_ _. _� ___ _____Depth of filter material...../__��----_--Total length------- ___ . Seepage .Pit: Distance to nearest welL___________________Distance from foundation--------------------Distance to nearest lot line__�a � (] Number of pits----------------------Lining material---:------------ -----Size: Diameter-------:----------- ----Depth------.----_--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----_.____.._____..Lining material__.______-.-__..__._..__.__________. ❑ Size: Diameter--- -------- -----=------------------Depth-------------------------- -- -,-- - ---I----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__----------------------------------------------Distance from nearest building--------------------------------.-------_ ❑ Distance to nearest lot line-- r-- ------ ----------------------------------- --------------• -------- ---------------------_--------: ------------------------------ Remodeling ---- 'Remodeling and/or repairing [describes= �L� �'('-t'C�` ----- '--•----------=----— •--- ---------:-. ------•------------------------ t . ------------------•----------------- ----------- -----•-------:-------•------------•---------------- ----------------------------------------- ---- --- ------------------------------------ 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. DAY&NIGHT ' �- Contractor (Signed)----''. �, --------------5aistac-Tur„��tacg--------------------------------- ---- •• .- -------------------------- - ---- ---{Owrtenaq�x- ) 1206 So. Eldorado HO 2-7046 By:- - - (Ti+le) ---------------- toc--k�toii; o if------- ---------------- --- (Plot plan, showing size of lot, 1ocatwn o system in relation to wel , buildings,.etc. can be placed on reverse side). i OR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- ------=-- --------------------------------------- DATE---- ----•------ --------------------------------- REVIEWEDBY----------- ------------- ----------------------------------- --- ------ `-------------------------------------------- DATE -- -- BUILDING PERMIT ISSUED------------------------------- ------- ----------------------------------------------------------• DATE Alterations and/or recommendations:------- ------------ ----- ----- ----- ---------------------------------------•--- -------•-•-----••--------- -------------------------•-----------------•-------•--•------ ------------------ -------- ---------------------------------------------------- y. � -------------------------------------------------------=---- ------------•---------------------..-----_-.--.-.---__--_-.-_-----------•------_--.---- -------- _------- ----------------- Date - - r ' 7 FINAL INSPECTION BY--- ------------------5--------•---------------------- ---- ------�--------- ---`----1 - ------ ---------------------- 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-5 145446 ATWCOD