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v('� APPLICATION FOR SANITATION PERMIT Permit No. ... .._lc___.1�._S. q-2j (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 AND LOCATION. :............ Yh!I-. -5 rt? ----•--•--. •----------- Owner's Name--•-•-. -�--'.&j3. ..... ------------------------------------- - ---------------------t ------ Phone, .► ' '��a1� ._ . Address...----•-...a ._... -------=--------- - =------.. `-•...Ak_ r r : --------- .. fes. Contractor's Name-------------------------------- r 'r -------------0.. ------ Phone.. .... . Installation will serve: Residence [t Apartment House.,❑ Commercial ❑ Trailer Court ❑ Mot-1-0 Other ❑10 a _ Number of living units: _; lnrnber of bedrooms . Number of baths ._ __ Lot size ,._." ._+ ___ ....._. ... ................. Water Supply: Public system, Community stem ❑ Private ❑. Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel n•. Sandy,Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application MdAeo Yes ❑ No4TIONS: New Construction: Yes� No E]TYPE OF WSTALLAT164 ANb—SPfiC - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-----------------Distance from foundation....................Material .._.............. No. of compartments-_____ Size....._..._ ______ _______Liquid depth---__----__ __-___:__-__Capacity, Disposal Field: Distance from nearest w 11 `'' Distance`-from foundatio .. _ __-. Distance to nearest lot line Number of lines..............: .----------_...Length of each line-------- ....Width of trench ----`L.-Q!-(- ------ Type of filter material____ __ _ r_Depth of filter material_........V`L_:__Total length.....................�$'-,v_--s__ Seep a Pit: Distance to nearest well --------------Distance f m"`foundation_•- O_-_-.Disfance tQ nearest lot line... Number of fits-:-_ ------------Lming material---- _- . " __-Size: Diameter._ 1P"_ ____.Depth------------6---------------- Cesspool: Distance from nearest well-------------._--Distance from foundation___ _____________Lining material___-------------- .................. El Size: Diameter. Depth- _. :• — Liquid Capacity. gals Privy: = Distance from nearest well.------------------------------------__. __.-----Distance from nearest building------------------------------I........... ❑ Distance to nearest lot line______________ _ _ sf ,,,�' Remodeling �! (describe):--------------- -/ _ _ "' .� / --------� ' ... ......... �`° -- .,. --- - -- ----- '�t�X ,X _W2,"W 4004.4—.me gAt fel..C-4g�cr.. _,RR.�---------- -----_-_--------_----- I hereby certify1ha+-Ihave prepared this-,application and that the work will be done in accordance with San Joaquin County ordinances, State fi w3;and rul and re2Ju tions of JRe n Joaquin Local Health District. (Signed) = ` ------ •-------------------------------- (fin ) By:................... .....••.. ..,..--................................................ - ------. •-•-•------------(Title)-------------_----------_------------------ ----------------- (Plot --- - ------ (Plot plan, showing size 46t, location of system in relation to wells, building"fc., carr be placed on reverse side). k SM FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -DATE_ g// .� (REVIEWED BY........ ------ ---•-- •--- - --� �" " ......... DATE...:_-. BUILDINGPERMIT ISSUED.-. .....=•=- --= ---------- ------------------------•--------- --------.- DATE--------------------•------------------....---------------- Alterations ansi/.or,recommendations: -- -------------------------- -------- _ ------ ---- -------------------------- -------------------------------•.._...•--..........-----------............ -----•--•--- ....................................-.......................................................................... FINAL INSPECTION BY:---•-------- ........................... --•--- Date..........0, � .......----------------------•-- SAN JOAQUIN LOCAL HEALTH DISTRICT - 130 South American Street 300 West OakItreet _ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca,_California Tracy, California ES-9-2M Revised W-2100