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k 3r PPLICATION"FOR• SANITATION PERMIT Permit No. (Complete in Duplicate] f,--- �'f Date Issued ____ _. i + n Joaquin Local Health District fora permit to construct and install the work herein described. Appl�ca ion is hereby made to the Sa 9 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION_______ ___ /___/__�__'__________c�________ ---- ------------------------------------------------------------------------------------------------------ __ b Owner's Name.----- = --------•- --••---------------------•----------- -------------- ----------------- Phone------------------------------------ � '` -------- Address----------•----- --�g---•' ------- --------- - Contractor's Name---------- --- ------ --------------------------------------------------------------- --- Phone?-57�A-41.6----- Installation will serve: Residence ljr_A�partrnent'House 0 Commercial ❑trailer Court ❑ Motel El Other ❑ i Number of living units: j--- Number of bedrooms..;;- Number' of baths __ -___ Lot,size __S �_/1.1d_d_�--------------I---------- Water Supply: Public.system [Community system ❑ IPrivate ❑ Depth to Water Table '7� t. Character of soil to a depth of 3 feet: t Sand E] Gravel ❑ Sandy Loam E] Clay Loam ElClay El Adobe [Hardpan F] Previous Application Made: Yes ❑ No New Construction: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well-sem_-Distance from foundation__,)d___!____-Material__ t/---------------_ _ - ------- i f 1 No of compartments___ =-a_ Size_'�J4_.. Liquid depth_....�y/..yaL______-__Capacity__Sy3_ _ _ ___ / Distance from foundation______..___=__.__Distance to nearest lot line----------------- . ..,_________. Disposal ' Id: Distance from nearest well�� °� D � Number of lines-------- 'r_ _-_ Length of each line______D___ _ :Width of trench.___, - __-.`-:----.-- r Type of filter material--S f __ -__Depth of filter material_.____,f 1?��_._Total. length_____ -�-__. I . - S., Seepag it: Distance to neare t well �_____Distance from opn ation____ __._._•.Dista6ce to nearest lot line_________________ I Number of pits---- -- 'Lining-material _'_'Size:'Diameter---s3 -------------Depth_ _..-------------- [IS Cesspool: Distance from nearest well_______________Distance from.foundation____________ _____Lining material____--______- ___.____.__________. ❑ Size: Diameter------ ----------------- ------Depth-----------------------------��---------------Liquid Capacity----------------------------gals. Privy: -Distance from"nearest well----------------------------------- -1Distance from nearest building--,--------------------------------------- ❑ -Distance to nearest lot line-----------------------------------------------------------------------'------------------------------------------------------- ---------------- Remodeling and/or repairing (describe):---------------------- --------------------1-1 --------------°---------- -------------------------------------------------------- .. . .. i c ---•- -•------•-------------------•------ -- --------•---------------------------------------- ----. -•--- -- --•----------•---------- -. ----------- -----------•--------------------------- • --------------- i I hereby certify that I have"prepared this!application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of the San Joaquin;Local Health District. {r {Signed) �j4�j------------------��(" -- ----------------- -- --- - -----Owner and/or Contractor) l -----------/_ '`'e "' • `�-------- {Ti+lel -- -- -------------------------------------------- (Plot ----------------------------------------- c� By: plan, showing size of lot, location f 7em in relation to wells, buildings, efc:, can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY_ DATE,'..--- ----------------------------------------------------------------------------------------------- REVIEWEDBY------------------------< "' .. . ---=---- ..--- .--------------------------------------- DATE_._ BUILDING PERMIT ISSUED- 4r- - --------------` - DATE------ k -•.•- Alterations and/or recommenda+ions:_---------`-------------------------------------------------------------------------------------•---- --•`•----•--------••------------------------------ k - - iE - - ------- �"'" - •-------------- -----•--•-- -------- _ _ '� t ----- . -- -- - � ,y ,� - 1 - � �L FINAL INSPECTION BY:------ ---- ...,.,----.-„--------- Dat"”" �f"�,;- ��..�� -� =---------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California