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\� APPLICATION FOR SANITATION PERMIT Permit No. --. ..- ..--- (Complete in Duplicate) SCANNEL�te Issued -...-...�.}./.s�. 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. JOB ADDRESS AND LOCATION_---.._ ..� S _------- �^ _ ---------------------------- ------------------ --------- --------- Owner's Name%,/'� - ---- - Phone-------------_ --- -- ------------- -- --- - -- - - ---- - - Address----•---- ... Contractor's ----------------------------------------------•----' - --_------------- --------------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/.__ Number of bedrooms _ Number of baths _-l.x:j_ot size __Z, D---J �D --------------------------- eter Supply: Public system Community system ❑ Private Q Depth to Water Table �'Oyft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No 0— New Construction: Yes IQ 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 we'll__ _;W'__.Distance from foundaton-_/�-...-....Material_ec- -�----^------ c/�? No. of compartments....-� --------Size._ z--- Liquid depth---, L---------.-Capacity... Disposal ------- Field: Distance from nearest welL�??.�_-,_Distance from foundation-----le!.._.Distance to nearest lot line._. Number of lines._.__ .-�.---.---__-_Length of each line_._...�i-O_-...�.j.-.Width of french.._-.._ / r---'------------ mate Type c filter crest ell---.;�._..S�Do th of filter material__..J.O--______Total length___._1_9_6-_--_----------- Seepage Pit: Distance to nearest welL.._ ---------....._Distance from foundation..........-.........Distance to nearest lot line-----...... ❑ Number of Pits__..._ -------------Lining material----------------------Size: Diameter------------------_---Dept h------__----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation...__..-----------Lining material... (� ❑ Size: Diameter- -- .. ....... ------ -------Dep+h.----------------- - -- ------Liquid Capacity------ --------gals. Privy: Distance from nearest well-----_._-----_...-------------.--------- __Distance from nearest building Distance to nearest lot line------ -------------------------- Remodeling -Remodeling and/or repairing (describe):-----_._---------------------------------------_---._._ , ------------------------------------------------------------------------------------------------------.......................------------------------------------------------ ------ -- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate , nd rules and regulations of the San Joaquin Local Health District. )Signed)--- _.....-7L7-----� ------'------'------`--------'-------- ---------------`------------(Owner and/or Contractor) By°vim— ---------------...(Title)----- ... ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---'-'-�--- --- ------ --- - - -------------- --------------- ---------- DATE.._-_..... ............. . - ------- - ---- REVIEWEDBY----------------------------- -- --- � ----------------_--------------- DATE...L_i_------------------- - BUILDING PERMIT ISSUED.... - - �` - ........ - - - DATE - ------ --------- - - Alterations and/or recommendations,:--------_-------------------..... .. -------- ---------------------- - -...............-� ------------------- 1.L f► - _.c. .. -----------_------------- - ------------ t ...-.. A :. .2�71'r,..i --- -----A _ ------ - - - =f F `- ---------- FINALINSPECTION BY:._---------------------------------------------- ----- Date - --- -------- ----_-----------------_...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S±rest 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E`r9-2M 145446 ATW... 12.4