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APPLICATION FOR SANITATION PERMIT la',,l D Permit No- --- ------ ----i. A n g i (Complete in Duplicate) Date Issued ------ f�S-(p 5 3.�- 4_- o.4r—v"..-E , z-,-/ ' 1 D?,5-200,z3 Applica*ion is hereby made to'�4he San Joaquin Local Health District for a permit to construct and install the work he in described. This application is made in compliance with County Ordinan 549. JOB ADDRESS AND LOCATION --- -------- - - -------------- ----------- ------------- Owner's Name-.-- J I ------=-.-- Phone------------------------------------ Address ---- ------------- -- �� --•----•--- .------ .- ' .1__ ..----- _ Address------ - •--r---'-�-•---- --•• -• - - - - - - - -----------------------------------------•----- I. /f-- Contractor's Name-------& � s/ ------------------------•. ---- Phonal - '-'Z a Installation will serve: Residence apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4 --- Number of bedrooms S.- Number of baths Lot size ----1.1?-0-----x----J--4_D --_ Water Supply: Public system`❑ Community system ❑ Private 14-'15epth to Water Table&.9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ ry Previous Application Made: Y�s ❑ No 93-�hfew-Construction: Yes ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) try I0_-�-Distance from foundation__--_ b F ----------- Septic ` Tank: Distance from nearest well-.- /-------------M terial----- ..----. ..---------...---------. �► W No. of corn artments-..-. ------------------Size---�(--�.Al�---Liquid depth-y.4.......--..---Capacity--4'�._P------ LDisposai Field: 'lom nearest well._�r------Distance from foundation---1O-'--.-_. . Distance to nearest lot line---S -�..-.. 41 Number of lines-_-- ---- --- --- Length of each line--- . Width of trench__2_kf--------------------- Type of filter material---J,'-------_._-_-Depth of filter material---.AP..........Total length_-_ ---------------------- Seepage -- Pit: Distance to nearest well----�d-P-._�-_Distance from fou dation---._�S-_._ Distance to nearest lot Ime----� Number of pits_._._V...�,�--------Lining material-:, ze: Diameter.-a� �'---._..Depth.-.. C�-°------------------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material--..---------------.--.--------------. Q Q Size. Diameter-------------- -----------------------Depth------------------------------------ - ---- ..---.--Liquid Capacity------------------------....gals. Privy: Distance from nearest-well--------------------------------- Distance ----------- --_-.--. ----_Distance fo nearest lot line------ -- --------------------------- ----------------------------------------f Remodeling and/or repairing'(describe):....----. -------------------- -------------•-------------------------------------------•----•--;-------:--------------- •-••-------------:++� I ---------------------- -----------------•------------•------------------------------- -------------------------------------------------------------....--•----------- ----------------------------•-----------------...._.--------------------- il ------------------------------------------------------------------------------------------------------------- = 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. R (Signed). --------11 .. - ------------------------------------ -------------------14 (Owner-:md75br Contractor) By------- -- r-- ---- ------(Title)- IM (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 APPLICATIONACCEPTED BY�------------------------------ ------------------------------------------•-------------- DAT -------------. -.----- -----------•------------ Cha REVIEWEDBY------------------------- -N----------- -- - ----------------------- -- -------- DATE_" ,' BUILDINGPERMIT ISSUED---�M------------------------ --------------------------------------------- DATE----.�__ _ -------------------------------------------------- Alterations and/or recommendations---------------------------------------------- - - ------•------------ �M r •-----------•------- -------------------•------------ ---------------- ----------- --- ----- -._?iC•L --------------------------------- .-..-..---------------------------------------------.-.----------------- II v ----- - 1�---------------'-•--- FINAL INSPECTION 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---g-2M 145446 ATWOOO 1254