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53, APPLICATION N o. FOR SANITATION PERMIT Permit ----------3 -------- 4; (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. This'application is made in compliance with County Ordinance No. 549. ---- ------ --- --------------- -----------I----------------------- ------------------- JOB ADDRESS AND LOCATION------- Owner's Name------------------------- ..e.......OV-0-------- -At--- ------------------------------------------- Phone_.------------------------------- .4 -----------------7-----------*---------Address-------------------- -- ---- -- ------------ ----- ... ........ . ----- - __-•---1-•-- ----------- Contractor's Name-------- -AV- ----------- - -- --- - ----- ----------- Phone Installation will serve: Residence Apartment House [] Commercial E]' Trailer Court rt [] Motel [j Other E] Number of living units: r of bedrooms 2- Number of baths/_--__ Lot size ------------------- Wafer Supply: Public system nify'sys%m'E] Private L]' Depth to Wafer,TablZa.-_ f+. Character of soil to a depth of 3 fee+: S ravel ❑ Sandy Loam ❑ Clay [j Adobe[1--5ardpan LLI Previous Application Made: Yes 0 No �� Ej New Construction: Yes []No 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-----------------Distance from foundation--------------------Material------ -------- -------------------------------- No, of compartments--------------- --------------------------------Liquid cleo�--------------------------Capacity---------------------.0-- I e from founclafion__J;��_ Distance to nearest lot line-113------- posal Fiel Distance from nearest wel;V ist Disposal �_ Di s 1 .4 __.width of trench_._. -------------------------- L6ngth of eac�-Iine----YZ Number o-i' lines-- __q Type of filter ma-�eritalW— I jj� t.Depth of filter material------/A ...Total length-----__---- _117-------------------- Seepage Pit: Distance to nearest well_----_"--._.---- --Distance from foundation--------------------Distance to nearest lot line--.--_----_---.-- \ ; Number ine----------------- Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth________-- ---------------------- Cesspool: � Distance from nearest well---------- ------Distance from foundation--------------------Lining material-----.--_-_-.-_------------.-..--_--- Nf ----------------------=z---- El Size: Diameter------------------ --- ----------------Depth------------------I------------------ -quid,Capacity gals,, 7 Privy: Dis�ance from nearest well------- --------------------------------- -------Distance from nearest building------ --------------------------------- - Distance to nearest lot line------------ ----------- ------ ----------- --- ---- ---- - -------- ---------- rr Remodeling and/or repairing (describe):______ -- -------------*_ --4�te .ze, ------------ ----------------------------------------------------------------- a--------------- ----------------------------------------------------------- ------------------------------- - /7y ... --------------------------------------------------------------------- ------------- ----------------------------------------I------------- ------- -------------------------- -------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'ordinances, S a /11aa 5, and rules regulations of-the San Joaqu:in:,Lo al Health District. .6 r T f (Signed)---- ----- --(Own ------- --------- Oqd/or CAractor) -----------------------(Title)------ -------- BY:- ------------ ---4Z---------------------------------------------- X�--------Al (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY --------- DATE-- - --- -------------------------- APPLICATION ACCEPTED BY�-- .___ - ----------------------------------------------------- - REVIEWEDBY-------------------------------%Z -------- --- --------I--------------------------------------------- DATE____`7. N-_------------------------------------------------ - BUILDING ------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations---------------- ----------------------- ---------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------ ------------------------ - ----------------------------------------------------------------- --------------------------------------------------------------------------------------------2-------------------------------------- ---------------------------- -------------------------------------------------------------------------------------------- ---------------------------------------- --- --------------------------__---------------------------------- 7A S3 FINAL INSPECTION BY:--------------` --------------------------- Date---- ------------- ---------------------------------------- �. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South'Arnerican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M �0-5.2 Rayised W-2100