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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued A r ereHn-de This is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo is application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION,__A_77 Z ---- .........13--q-A........�_Z----�/------0- / Owner's Name------- ----_---------------------- -------------------------- ------------------ Phone./ Address.......... ------- ------------------------------------------------------------------------------------------------------------------------------7------------------------------------------------------- Contractor's Name------ ------------------;------------------------------------------------------- Phone-/&----- Installation will serve: Residence [Apartment House El Commercial E] Trailer Court [-I Motel E] Other L] Number of living units: _J--- Number of bedrooms __-Z__ Number of baths ----4 Lot size --- =__________-___.____ Water Supply: Public system E] Cor�munity system El Private � epth to Water Table L1774 ft. Character of soil to a depth of 3 feet: Sand Ej Gravel E] Sandy Loam E) Clay Loam E] Clay E] Adobe LM Hardpan E] .Previous Application Made: Yes E] No EX�New Construction: Yes 14—No El TYPE OF INSTALLATION. AND SPECIFICATIONS: (No septic tank or cesspool permitted if public,sewer is available within 200 feet.) Septic Tank. Distance from nearest well......go ....Distance from foundation-----5 6--------Material-e, No. of compartmer).15------_-2----------Size...... (P---- Liquid clepth------ --_C?------_._.Capacity_..--- i-------- Disposal Field: Distance from nearest well......&_,___D'sfance from foundation----__c------Distance to nearest lot line.,,- Number of iines-------- --------Length of each line------ of french- --------------- r filter material---- ......41 ,,JR,_-Depfh of filter material--- ,./- -Type oT --_-Total length---------- ------------------ Seepage Pit: Distance to nearest well-----/1-0_-----Distance from foundation......&__0-----Distance to nearest lot line__..2,ft1__. 19 Number of pits------/--------------Lining materia;.t�_e_j94._,4&: Diameter------- Depfh---,-;Zo................... Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-__-_.__________.__.____.___-____._❑ -. Diameter------------------------------------ -------- ----------Depth----------------------------------------------------Liqu;d Capacity-.-------------------------gals. Privy:- Distance from nearest we]-------------------------------------------------Distance from nearest.building-_=---------------------------------- ❑ Distance to nearest lot line--.----- ------------------------ - -------- - ------------------------------------ ----------------------------------------- -------- Remodeling and/or repairing (describe)---------- ----------------------------------------------------------------------------------------------------------------------------------------------i ---------------------------------------------------------------------------------------------------------------- ----------------• ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- -__--------------------*'-'-,*--------*---------------------*-------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State S, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ -------------- ----------- -------k------ ---0_�,-�_ ------------------------------------------- --------- -------(Owner and/or Contractor) By:------- ----a-, ------------------- -----------(Title)----•---4 ------------------- --------------I.... (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-------. ----------------------------------------------- REVIEWEDBY------------------------- ------ - - ---- - - ---------- _IZZ--- ------------------------------------------------------------ DATE---_---- ---- ------------------------------------ BUILDINGPERMIT ISSUED.--------------------------------------_ -- -- ---------------------------------------------------- DATE.--- ----- ----- - ---------------------------- Alterations and/or recommenSkafions:------- --- ------------- ...... -------------------------------------------------------------------------------- ---- ---7-S__ ----- W ------------- ------------------- - ------ -------en- --------- ---------- ---------------------------------------------------------------------------------------------- --------- ----------- -- tA-------------- 40------------ -------------- •--------••- ---------------------------------------- ----------- ------ ---- ----------------------(::�-----------I------------ ------------ --------------------------------------------- -------------------- ------------- ------------------------*......* ---------------------------------------- --------- ------------------------------------------------------------------------------------------- ----------------------------------- ,/_j ----------- .................. -------------------------------------------------- FINAL INSPECTION BIE; ------------------------------------- Date....3_1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2m t4G446 ATWnnD 12-S4