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APPLICATION FOR SANITATION PERMIT a' .Oermrt No. (Complete in Duplicate) Date Issued ___ _ __ ------- (o Applica�ion is hereby made to the San Joaquin Local Health District for a permit t o str t nd i all the Vworkr indescribed. Thisapplication 'is made in compliance with County Ordinance No. 549. r JOB ADDRESS AND LOC/ATION_... I Owner's Name--- Q_IX.... , D --------- ------------=--------------- ------ Phone.. Address.........../1.6-0.In-----y--N-0-- /.....C,47 1.5' Contractor's Name 1 :/` FT. ��1G,L �'r�i------ �----AL__C----------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .I. Number of bedrooms'0-• Number of baths 147 Lot size ------ ------ ,. ------------\/71 Water Supply: Public system ❑ Community systemSL—Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RHardpan ❑ Previous Application Made: Yes [] No §d_.New Construction: Yes X_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � r Septic Tank: Distance from nearest well ___ Distance from foundation_-_I_ O_ ._....Material_____L-_L_Q -- C____ C DL No. of compartments......-�---_-------Size--..�&--- ---Liquid depth-------�Q..Q----------Capacity----or:4__' a < Disposal Field: Distance from nearest welLA5?q----Distance from foundation.____--2-J------- Distance to nearest lot ua__ Number or' lines............ ----------Length of each line---------;Z5------_------Width of french------ZZ-V------------------ ,�- material - - - Type of filter material_-__/5-._. Depth of filter material_._.../-$_._____Total length___----_'71d-------------------------!, Seepage Pit: Distance to nearest well_ _-.r---Distance from foundption_--..;k!q-----Distance to nearest lot line__.�4..____a [ Number of pits.-----I------=------Lining Diameter-----'-__`.r�-...�_Depth-----�� _.---------- � Cesspool: Distance from nearest well-----___-------Distance from foundation.---_.-_---------- Lining material-- ---------------________--- I USize: Dameter-------------- ----- - -- - Depth----� ---------=----------------------------------Liquid Capacity-------------------------•--gals!, Privy: Distance from nearest well____------------------------------------_----------Distance from nearest building-----------------------------------------I- ` ❑ Distance to nearest lot line------------•----------------------------------------------------------=-- Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------....-----•--------- •-------••--•----------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- --------------------------------------------------------------------•----------------------------------------=--------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------=•-------------------------------•-•------------------------------------ I hereby cer}if hat 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, and rules and regulations of the San Joaquin Local Health District. (Signed) - ` . potper and/or Contractor) w $y:._.- �G�?�- +—�-r�•.•-rte .•----------------(Title).:.. --- -----..f-------•-------------- ---------- (Plot(Plot plan r showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ — .----- ------ - --------------- DATE---------�----------------------------------------------�. REVIEWED BY fir'` --------------- ------------------------- ------------- DATE----------- BUILDING PERMIT ISSUED-------------------------------------- # `-F-- - ---------------------- ------------------- - -------------------------------. DATE..------------••-----IS---- ------------------•------•---• ; A[}eratians and/or recommendations: ---- - ----------• ---- •e------------•---•----•--- s ------ - --- ---- -- - .� . --�; = ----------------------------------------------------------- ------------------------ .---- �le-------- ------- ---- ----- -------=---------- : ---------------------------•--- .--- ------ ------ l FINAL INSPECTION 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 E5-9-2M 145446 ATWOOO 12-54