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1 ((LL r� Permit N APPLICATION FOR SANITATION PERMIT o. .--- -------Z.------ V (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_.__3/4—.2— 4191ffG rlee-e------------ ----------------------------------------------------------- -_-.------------ Owner's Name----------- r > R"i-Lk,1610L/-1—----------------- -------------------- - -- ---------------------- -- --------------- Phone------------------------------------ Address--------- ------------ 0 Z L-`-�-4-s`- `a,, * -------------------- --------:...--------------------------•-------..-.-..-------------- � Contractor's Name. - a! r Q+.-_ ------------ Phone__ Installation will serve: Residence ❑] Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: _ fJ Number of bedrooms ___.._. Number of baths -------- Lot size �s-`.� - ___f _ Water Supply: Public system + Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well._:_____________Distance from foundation-----------_--------Material------------------------------------------._____- { ❑ No. of compartments-------------------- ----Size--------------------------------Liquid depth--------------- ------Capacity----------------------- l Disposal Field: Distance from nearest weli----_-------- Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines---------------------------------Length of each line-----------------------------"Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material____._._._ � al length_______.____________-_---._..-_/________- Seepage P' . Distance to nearest well_ 0i _-___Dist15,�undation ation___ _ __�____.. ista ce to nearest lot line__.__1 - Number of its... Linin ma rSize: iameterA4�"�__...___-DepAh _____________________ p g Cesspool: Distance from nearest well___.__________.Di ____________________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):------------- --------------- --------------------------------------------------- -------------------------------------------------------------- --•---------•-------------------------•--------------------------------------•---------------------------------------------------------------•-----------------•------------------------------------------------------------- -------------------- ------- --=--------------------------------------•----------------------------------- ------------- ----------------------------------- - I he 6y certify have pared this application hat the work will be done in accordance with San Joaquin County ordinances, to laws, a rules regulations of t an Joaquin,Local Health District, (Signed)----------- -- - - `�--�---------------------------- ------ -------- ---------"• ----- ---------------------------_,L -�l Contractor) rt ( -. --- - By:--------------------------------_-------------------- ----------- ---- ----- ---- -------------- ----- -----------Title - (Plot plan, showing size of lot, location of syste in relation to wells, b I ings, etc., can 6e placed on reverse side). FOR DEPARTMENT U E ONLY APPLICATION ACCEPTED BY-------- ---- ------------Z--- __ __ _ _ DATE-------- -- REVIEWEDBY----------------- --------------------. ...... -- ------------------ ------------ -------------- DATE---------------:t-�--- ---------------------------- BUILDING PERMIT ISSUED---_------------------- `'- ------------- ------------------- DATE __J�N----------------------_--..._ Alterations and/or recommendations------------------ ------- -- ---------------------.------------------------------------------------------------------------- 1'_N -------------- -----------------------------------• ----------------- ------- -------------------- ------------------------ -------------------------------------------------------- ------------------- ----------------------------. . ----- -- ---------------------------------------------- ------ ----- ---------------------------------------------- -------- --- - --------------------------------------------------------------------------- FINAL INSPECTION BY-------- ------------------------------------------------•----- Date------- ------------------------ y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California ,_Tracy, California Es—r-2M 145446 ATwaoo IZ-54