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APPLICATION FOR SANITATION PERMIT Permit No. .-..far!t�.... 42-10 (Complete in Duplicate) scANNEC to Issued ___.�................ Appliceion 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 ANDATION-.-- ` -... ---. -L-- O9/p U -------------------- Address - - - - --------------------- - Owner's Name- --- - g�L-- _ Address-------- j!!D p L Y.,I_X 51-v-------------------------------- Contractor' -......-------------------- - - - - --- - - --.. Con+rector's Name-.-.. -S/--- :�-/S� '-- ----- ------ -- -- ----------------------- - ------------- Phone..-------------------•---------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ le Number of living units: _- --.. Number of bedrooms _.;2:7 Number of baths -/--_ Lot size / U_--_-..- 1�. _0 Water Supply: Public system ❑ Community system ❑ Private L;_-Depth to Water Table,j-20ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M—Hardpan ❑ Previous Application Made: Yes ❑ No ®/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 well Distance from foundation_._........_..--Material -_-----_--_--------------- ❑0A25No. of compartments----------... ......------Size--------- ------------'-------Liquid depth._.-----...-------...._Capacity--.---------------- i � Disposal Fi Distance from nearest well._7.>__.-Distance from foundation..--- to nearest lot line._2tL..-... Number of lines------ ---------/ --------Length of each line------.--Gt-J'--i---_-__.Width of trench----_ Type of filter material..__.L��F. s.K...Depth of filter material--_---ZS_-'----..Total length_-----_-�_2 ........-........... Seepage /Pit: Distance to nearest weIL.lGQ..i------Distance from founds+ion__:2,.r1_... -....Distance to nearest lot line.- Number of pits-----/---------- Lining material.- t'.. .'.54--.Size: Cesspool: Distance from nearest well--- ---------__Distance from foundation........__.. Lining material .._.. -------------- ------__._.. Q ❑ Size: Diameter.-------_....-----------....._----Depth-----.._---------- --- -----------------------Liquid Capacity---------'..... .......gals. Privy: Distance from nearest well------____--.....__._-.._..........___Distance from nearest building_--- -_ -------------___________... ❑ Distance to nearest lot line ------ Remodeling and/or re airin describe :-. . CL ll t / ,"Ie _ 1-- -----------"----------------------------------------------------------------------------`---------------------------. ----_.. --------------------------'----------------' ..-----`---------- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stoe-)laws, and rules and regulations of the San Joaquin Local Health District. t1_4 (Signed)...... -_ ! _C-/-_-------- ---- - (Ory and/or Contractor) (Plot plan, showing size o lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __......._ .....- DATE __._...-..... ... ............_.. REVIEWED BY - - ------------------------------------------ DATE - v� - BUILDING PERMIT ISSUED -- -- --------------------------- --------- DATE----------------------------------------------- Alterations and/or r'commendations: -------- ---------- i--: ------------------r ------------`-----------........ ......'- .. *.. . -'Y(.-.... X . +TY n w............ ' ............................................ ----------__________________________JA'--------------------------------_----------------- --- ---------.. --------------........._---_.....--.j_._.._...----------.-____..-.....--_-......._--_--_..__........_- --------------------------_____._____-_-------___--___ ------.---------- - FINAL INSPECTION BY:. - Date- --- ---- SAN --SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 8I4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E.— 2M 1g..AT.... 12-54