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! APPLICATION FOR SANITATION PERMIT Permit No. .-- ---------- (Complete .-------- Com lete in Duplicate) f / PDate Issued .__7�-,1-. fen5 . .� ! �rf�+wtia a #" �--�,), 177—oj,O 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. 549. C ' JOB ADDRESS AND LOCATION...+�., .� Yh., „�..., �!l� � r-.?Qa ..-spa..�lr. I. Owner's Name ---------,c?a��]" ----•-------- r � i Phone------------------- A ----------•------` Address. ------------------------------------1;71,-7-`------•(: "�.Ac�Yt-- - a ` =t - Contractor's Name------------------- ---= - ------------------------------------------------------ -------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E❑ Other ❑ Number of living units: --f--- Number of bedrooms -3-.. Number baths -A Lot size _�ol'`__X__40.e - ...-•... -------------••--------•- Water Supply: Public system El-'-Community system ❑ Private Number 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 Sand Construction: Yes to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well0---.------Distance from foundation-/�--..._----. Material_ ® No. of compartments.--_2, ,_.__------------SizelW_.-A4--s _!S7Uquid depth----.�_{--------- ___-_Capacity._ Disposal Field: Distance from nearest well_/_4-U.____._Distance from foundation"! to nearest lot line-- Number �--_--_- tin Number of lines _ Length of each line______ Width of trench--'.' 'a_ r___-__-------_-- "l ® j� g ` r, �. Type of filter material--S=r_ C•3 .-Depth of filter material------I-� -------Total length----------�8------------____ Seepage Pit: Distance to nearest well---------------------- from foundation-------------------.Distance to nearest lot line----------------- �b ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth......--------------_--------__-_ Cesspool: Distance from nearest well-----------------Distance from foundation....------- ------- Lining material--____----__-.--___._--.---_-_----- T1 ❑ Size: Diameter--------------- _-:----------_-.--;--.-Depth--------------;-------•----------------------------Liquid Capacity-_------------------------gals. Priv Distance from nearest Distance from nearest building ❑ Distance;to nearest lot line- ---- -------------------------- ••------------------- i 4' Remodeling and/or repairing (describe) ------=-------------------------------------------------------------------------------- ------------------------------,-.----------------••- ------- •-----•---------------------------------- ----------------- --------------------------------------- -----•----------------:-------------------- -------- - --------------------------------------------------------------•--------------------------------------•----------------------------------------- I hereby certify,fhat I have prepared this-application and that the work will be done in accordance'witli San Joaquin County i ordinances, State jaws, and rules and regulations of fhe San Joaquin Local Health District. Si ned ( g )...-•:•� - ' --�1�- ------------------------------------------------------------ - -- )Owner 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). FORS@ AR ENT US NLY APPLICATION ACCEPTED BY. =`-------------- t DATE � ''f REVIEWEDBY--------------------------------------------- ------------ ---------------- ------------------ --------------------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------------- DATE----------------------------------- - ------------------- Alterations and/or recommendations---��w -----•-----I----- ----u+� ...-i,=--- ----------- -- ---•-- -- ---- - --------------LQ---------11.x----------- a'�- -----=- - --------------------------------------------------------------------------------------------- --------------------- -- ------- ------------------------------------------------------------- FINAL INSPECTION BY:------- .. _ - ---- ------ Date--- it fIV SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree} 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California s /E9-9-2M 145446 ATWOOO 12-$q