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r Lo ` APPLICATION FOR SANITATION PERMIT. Permit No. 4_�C_ ._..(f. (Complete in Duplicate) ,Z Date Issued Applies+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AN LOCATION---- yyam�.,. /1 -----(.... - -----------------------------------------------------------•------......------•--------- Owner's Name------ •--•- '!!_ -- Phone---s37J9 7�. .. Address-------------------- .....1%• --•- --•--,------------.-- ---------------------------------------------••----------------------------------------•-•------------......--•---------- Contractor's Name......... ---Gly-rt- ------ ------- ----------------------------------------------------------------------- Phone _ Installation will serve: Residence 2--'A' partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---)__ mber of bedrooms _4_ Number of baths ../___ Lot size ._., - -------- __,lZ-d_•_-__•-----__--•-_--__-• Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _A4-'-Qft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam [-] Clay Loam ❑ Clay [3 Adobe Er-1-Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ,L (No septic tank or cesspool permitted if public sewer is available within ZOO feet.) Septic T nk: Distance from nearest well-----------------Distance from foundation....................Material______-_______--____-__-_..._.._.__.._._._______. ,, a ❑ No. of compartments--------_---------------Size--------------------------------Liquid depth------------------------- Capacity "�D Disposal ield: Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. ❑ Number of lines___________________________________Length of each line------------------------------Width of trench................................... Type of filter material---------------_---------Depth of filter material--------------------___Total length....................................... Seepag it: Distance to nearest well------' 7.__.Distancf�m// oun ation____ ___.Di t c� to nearest lot li j ... _.____ Number of pits--------j.__--____Lining material__._______S ?-_4_- _Size: Diameter_._.._- J._______.Depth_-.. �_______________ ; J Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material••--_---__--_---___-.--_----_________. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------•---gals. Privy: Distance from nearest well-------------.-----------------------------------Distance from nearest building------------------- :•_•-•-•--_:-______--. ❑ Distance to nearest lot line------ -------------------------------------------•---------•----------------•------------------------------------------------=---------- Remodelingand/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, State I and rules and regu40� ns of the San Joaquin Local Health District. (Signed). --------- -------- ---- _j '--------------------------------------------------------------------- ------jjow 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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ................................................ DATE..............,G...=1_0 REVIEWEDBY-------------------------------------------- DATE------------------------------------------- ••............. BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------- --------- Alterations and/or recommendations------------------- -------------------------------•----------------------------------------------------•-•• ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------•--------------------------------••-•--- -------------------------------------------------------•---------------------------_........................................... ------------------.._....-------------------------------------------------------------------- ---------------- -------- ------------------------ ------------------------------------ - -=---•--------------------------------------------------------------------------------------------------------------------------•-- f� aZ - 0 r s�, FINALINSPECTION BY--------------- - -------- -------------------- Date------------------------------ ................................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100