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APPLICATION FOR SANITATION PERMIT Permit N ......... (Complete in Duplicate) Date Issued ��:......:...... 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 AN C ON------- 1/-,._�_-`....---Zao------Ahot `-,,6 0S----------5 Owner's Name...... ------- • . ........ ------------------- --------- Phone.A.--,2-_7S73 Address.•...-------•-. - ------ ..................................... Contractor's Name -------------- . _ _��.17--. Phone ' G�, Installation will serve: Residence Apartment House F1Commercial [-] Trailer Court ❑ Motel E] Other -F ❑ Number of living units: __`____ Number of bedrooms Z'_ Number of baths -_--_ Lot size ___-7.OLy_!—+ .� _--- .� ___ ____________________ __ L Water Supply: Public system %. Community system El Private ElDepth'to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam El Clay I] Adobe 'Hardpan ❑ Previous Application Made: Yes E] No K New Construction: Yes X No F1 ` TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-NWAP""Distance from foundation.-J"�--------...Material- - --•---. No. of compartments--,�._-._._._•-____-_Size_„�G?".��0__ _�_,Liquid depth, "r!�..___.__.__Capa qty.. ________ Disposal Field: Distance from nearest well,444Lst-.Distance from foundation...l�Q-----------Distance to nearest lot line--- __ ...... Number of lines__ ___ ___ ___________ en th of each line____ .f1 _ Width of trench.-. - ----------Total length----------TYpe of filter material -- r C epth of filter materia Seepage Pit: Distance to nearest well./K%41-t9Z_@_Distance from foundation_._..+ ___..Distance to nearest lot line--/'/<—.* Number of pits._0?�_____Lin Lining mateal._461K.LC/.Size: Diameter___.�i.r_._i......Depth---- ............... 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--------------------------------------------------•-----•------------•----------------------------------------------••----•--------•-------- Remodeling and/or repairing (describe)'_„---------- _._--------- ------------ - �... `” -------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certZnd repared this application and that the work will be done in accordance with San Joaquin County ordinances, Stateand regulations of the San lin Local Health District. jY__(Signed) -7Pi�buildings, (Owner and/or Contractor) By:... 0- -(Title)........ ... ........ . !------------------- ---------- (Plot plan, showing size of lot, location of system in relation etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- ------------------V-�. --------- ------ DATE-------- •��'---- "` -------------- REVIEWEDBY-------------------------------------------------------------------------------------- ------------------- --------•- DATE............................................................ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE............................................................. Alterationsand/or recommendations:------------------------------------....___............................................................................................................... ------------------•--•--•-•----•--•------•-----------------------------------------------------------------------------------------••-•--•-------•------•------••--••------------•-•-••-------•-••------•--.......--------•- ............................................-------------••-----------------------•-----------•-•-•- ----------•--------------------•-------------------•...............--------- -------------------................... ----------- -----------•---•-•----------------•------------•-------•---------••---•------.----•------------------------•--. . .. FINALINSPECTION BY---------------------------------------------------------------- r FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 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