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APPLICATION FOR SANITATION PERMIT Permit No. _---- ..___----_____ (Complete in Duplicate) Date Issued __J__ .E ...... 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. 5AA1 } JOB ADDRESS ANDe.L h '�' � --- ----- -------'- - '- ------'--- Pone------------- Owner's ----'------•-C• - - •- -Owner s Name---- ------••-- --- ----------Oi - -- 97- r -- VC-1---------------------------------------- Phooe _ _�� ''f(9 :- Contractor's Name __ -_��-- -`=�-- --- •-- Installation will serve: Residence'K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ------------------•- Number of living units: Number of bedrooms �/'. Number of baths _1----____ Lot size ---�.5.---X-�--E1O---••-•- i -.�--___ _ .__ Water Supply: Publici system ❑' Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No 0 ,_ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d Septic Ta`k�,,/V&Distance from nearest well__ ----------- Distance from foundation--------------------Material_____:_______"--______._____..___________-___. ]� ❑�X No. of compartments--------- ----------------Size--•-----------------------------Liquid depth------------- ----------Capacity----------------------- Disposal Fiel Distance from nearest well. ......Distance from foundation____________________Distance to nearest lot line___._______-.- ❑��,� i Number of lines ------Length of each line---------------------- ------Width of trench---------------------- ------------ El ------ --- ". Type of filter material---------___________--.-Depth of filter material----._.__.__..--1___.Total length____-____________-_______-______._.f r Distar��e to nearest lot line__.,_______. Seepage Pit: 1}istance to nearest well___15[Oay ---Distance from fo dation__ -------•- Depth________ .__ NA Number of pits___ -------'-'-- 5 'fes �Y��-_.__Linin material.__ .�i_ .__. -..Size: Diameter___. Cesspool: Distance from nearest well_________________Distance from foundation--_._____--___.__..Lining m''aterial_____...............________________. Depth -Liquid Capacity-------------- -------gals. '- ❑ Size: Diameter----------------------• ---------- C Privy: Distance from nearest well_:__..____"-------------------------------'-- Distance from nearest building------------------------------------------ FIN ❑ ----•-------------------- Distance to nearest lot line:_-------------------------------------------------------------_ Remodeling and/or repairing (describe):__:__._ ._ ltl , ---- . 4 -- --•--- ----------------------------------------------------------------------- ---------------- ---- -------------------------------- ----------------------- ------------------------------------- - - ----------•----=---------•---------••---•-------------------- -------------------------------------•------------------------- I hereby certify that I have prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State Iwrs, an rul and regulati �s of the S oaquin Local Health District. q Z (Owner and/or Contractor) (Signed) u 1. ----- --------------(Tit) ---- By:-----------=------------ - --- --- . e) A (Plot plan, showing si of lot, location of system in relati to wells, buildings, etc., can be plat F everse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -------------------- --------------------------------------- DATE-------- ---------------------------------------------- ---,DATE ----•---------------------------------------- -DATE:----- --•------ REVIEWED BY-----------------=------"----------------=--------------�---------------------------------------------------- " DATE------------- - BUILDING PERMIT ISSUED ----------------------------------- Alterations and/or.recommendations:..................... -' ------ -•-- f ---------------- 9---------- d- ' eGar ------------------------------------------ FINAL INSPECTION BY:------ ------------------"--- ---------------- Date-------//.......1 •----- -----••------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South Ameria'an Street Trac California Stockton, California Lodi, California Manteca, California y. �S-V-2M 145446 ATWOO❑ 1Z-54