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APPLICATION FOR SANITATION PERMIT Permit No, ._ . '...:: (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___: S_S•. 4_Al _---- Owner's Nat/� i . -�'P 10 Ev-e.TS ; Phone7Q:7` - --A � Addressm�,- --- --- - --•-- _ 7------- --- i & .------.. M Al Contractor's Name t l5_-_ C R u -p--— ----- C ------------------------------------------ Phone................................ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size .......................................................... Water Supply: Public system E] Community system E] Private F( Depth to Water Table7s-.G'#_41- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes V No ❑ New Construction: Yes V No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan _075 �'o ---.Material ------- ._ _.. Distance from nearest well..,... Distance from foundation .... No. of compartments---- �..Size_ .n�_x 5�x_G`__8° Liquid depth-----V-1.. ------.Capacity----. Disposal Field: Distance from nearest well._$.A.o---Distance from foundation-_I.—0- --------Distance to nearest lot line._"1.4,___-_. ✓Q Number of lines-------'L_jQ...................Length of each line--_-9-5..................Width of trench .o._o........ Type of filter mate ria I_5+c>Qe---------Depth of filter material---- _'.-4-------Total length--------------._-:2..._w_Q...... Seepage Pit: Distance to nearest well...............___._Distance from foundation_-___---_-____._-._.Distance to nearest lot line----------------- El _-_...._-_--. _❑ Number of pits-----------_.__.-----Lining material.......................Size: Diameter._._-..__..-___._...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------------------------------------------ F-1 Distance to nearest lot line---------------------------------------------------------------------------•------•----•----------------•---•-------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------•--------_----------------------- --•---------------------------------•----- - --•--•. ----------------- ---------------------------------------- ---- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. l .. . a`+G - Owner and/or (Signed) ,1 -------------•-..------ -- -- / Contractor) By:-•---•--- ....,�-- - - ------ ----- ---- --------------------------------------------(Title) 04-Ai. `' ----- (Plot plan, size of"lot, location of system�n relation to wells, buildings, etc., can 157-placed on reverse i e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---- ---- --- -- ----- ------------------------------------------------------- DATE-------- . ;,, REVIEWEDBY---------------------------------------- - ---- -- ------ ------------------------------------------------------ DATE BUILDING PERMIT ISSUED------------_- -- ---------------------------------- ------------------ DAT . Alterations and rec mendati s:..,22_-._ `�• � - .. - .. -------•----------------•----•--- --------------- - -- --- --------------•------------------------------•-------------------------- ---...---------------•-------------------- 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 ES-9 145446 ATW000