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- . IPit h q APPLICATION FOR SANITATION PERMIT Permit No�-- -._- - 1 - y! S (Complete in Duplicate) V 421 a SCANNEDDate Issue Application - ' 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. JOB ADDRESS AN CATION_$--4-- .......... Y Owner's Name. Q �� - � ll-L_117. L1. i------------------ -- �y---�-d -r- � _ -- - _ Phone -9-.K - Address..-------------------------- --- ---- ... - -- Contractor's Name------------- ---- ---'�f--/--1 - -�i -- - - �-------------- --------------------- ---------------------------------------- ------'----- --------- Y--- Phone- -F-� - y - Installation will serve: Residence Apartment House F] Commercial ❑ Trailer -----Court ❑ Motel ❑ Other ❑ Number of living units: -�..._ Number of bedrooms 1,-. Number of baths ./----- Lot size ._. Water Supply: Public -system ❑ Community system ❑ Private 9 Depth to Water Table.xs-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6(( Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-------__ _ _ _ _ ---._.Distance from foundation .. . ____.., ..Material_....._ ..... _ _ _ _--- - ❑ No. of compartments----------- ---- -------Size--------------------------------Liquid depth -- Capacity_... a P Y p , Di os I Field: Distance from near f .7`2 Distance from foundation _.�_ �.___. y� 4�+r /� Distance to nearest lot hne-�Q / Number of lines--- - Lengfh of each line-- i YP ytf P ` r_�-C/-- ty?/._...Width o trench..-��-- -- - -- Type of filter material Q� a th of filter material. _.. jS Total length..-_.._'_.71,�_/¢PiQ -I - Seepage Pit: Distande to nearest well-- -- -¢__---- Distance from foundatron----------- ._.__ ____._.,.Distance to nearest lot line----------------- El Number of its.--------------------Lining material-----------------------Size. Diameter---- ------------- ...-De tn__..- Cesspool: Distance from nearest well_-__.r__-.-_.__Distance from foundatio,-._ ._._------_lining material..__._-__k- v : F1Size: D'iameter------'---------- ----------Depth ----- ---------- -----------Liquid Capacity-------� ---------------gals. Privy: Distance from nearest well.........----._-_._. . _......_._.....-_.Distance from nearest building.. ❑ Distance to nearest lot line.� --- ------ 9 --___-_--., _�_ �..�,�'(- - - - - -- -----�--_- -- ----,..._.. Remodeling and/or repairing (describe):-. --- ---- ---- - --- ----... .----------- ' -- - - - ' y� - - ' --------------------------- - ' I hereby certify that I have this _Ica+ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r s nd�y uflatio(n,7s j/f the Sa Joaquin Local ealth District. (Signed)------ - -- --� ��LJ R-------- - - -__(Owner a or Contractor) By:--------- - ... - - - - ------(Title)------ ------- ----------- -...:�-. (Plot plan, showing size of bt, oea+ion of system in rale ion to wells, buildings, etc., can be plea on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_---------------- ..._.._ DATE_._._ t REVIEWED BY -- - -- -- - -- - - - - - ------- DATE------- ' -------------------------------- BUILDING PERMIT ISSUED_-------------------- - - -- _. DATE----------- - - - -- -' Alterations and/or recommendations:,......................_......,--.--.-----,-__--_-_--__�._�- - -- ----------------------------- ---------------- -------- - - - ------- -- ------- -------- ------------------------ ------------- -------------------- ----------- - - - --- --- ---.----- FINAL INSPECTION BY: .._... . . _.- Date �JI� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 131 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ifES-9-21A 10 52 Revised W-2100