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Y APPLICATION FOR SANITATION PERMIT Permit No. ___?1 :_-. /�tA�,pplica+ion (Complete in Duplicate) bate Issued is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND COCATI j� -3-0•- �6. Q;= - ------------------------ -----------------------------------•----................. i Owner's Name .... � -------- -------------------- ------------------- ------------ ----------- Phone ---�-7 I�. ...... AddressQ� ------------ ------------------=----------------------------------------------------------•---------------------: A ��- Contractor's Name_. ---------------------- ------------------- ---------------------------- ----------------- Phone-3-"3 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E � Number of living units: _. 2---- ® IV1 J---- 'umber of bedrooms _ _ Number of baths .__�___ Lot size . - ------------------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabl �__ t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy loam ❑ Clay Loam ❑ lay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E"No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) Septic" k: Distance from nearest well__. osft._-Dista ce rom foundation___i�_._..._.__.Material €-- -_- No, of compartments.___.___. #. ..__Size-- -_ __ ___ __ Liquid de th.' __. .+� __._Ca acit ___________' �. Disposal Field: Distance from nearest well.: "_.._Distance from foundation_ApP j-Q--.Distance to nearest to pipe_25_____------ Number of lines_------------- ---- ..---Length of each line__- k�__.. ----.----._.Width of trench._._�`_ " r 1 ' Type of filter material- *..________-Depth of filter material...V? -_ ---Total length.___s ___ ?- --_-------- ----- I If Seepag it: Distance to nearest well_.�*A_Q-__._.'-Distance from fou dation _- 4__.Distance to nearest lot 4q.-lir---------- i Number of pits-:__.I-------.-------Lining material ____ ____ _. _.Size: Diameter--.3a..............Depth___��_'._____._..______ c Cesspool: Distance from',:nearest well-----------------Distance frorR foundation...............- Lining material-___-...._--___-.._.___-._-__-_____-. ❑ Size: Diameter--`--- --------------- ---------------Depth----------------------------- -- - ----------------Liquid Capacity----------------------------gals. I .r � 3 �r Privy: Distance from nearest well---------------------------------------- -------Distance from nearest building----------------------------------------- d i ❑ Distance to nearest lot I,ne-- -----------E --.:--- - - -------------------------•----•--------------------------------------------------------------------------- .Remodeling and/or repairing (desc.ribe)= - ----------------- - - ------------------------ ----------- ------------ ------••--------------------.-.-----------------•--•--•- t ------------•-••-------------------------------------------------------------------------------------- -------------------------------- ---•--------------------------------------------------------------------------•---- ---- --------------------------------------------------------------------------------------------- - rr I hereby certify that I havere ared this a lication and that the work will be done in accordance with San Joa uin`Count f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signed)-------- --• -------------------------------------- ------------------- -- ---------------------------------- ----------------------(Owner^and/or Contractors . l By:---------- - ---- •---------4 ---------------------:------------•_= --------------------------------------{Title)----- (Plot plan. showing si of lot, coca n of system in relation to wells, buildings, etc., can be placed o everse side). f FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY_'------------------- --------------------------------- ---------•-----•----------------------- DATE_��_�. --------------------------------------------------- REVIEWED --•--•------------------- .---------•------------REVIEWED BY-------------------------- v f _ DATE-- =- .:r -------------------------------------------------------------------= - �� --------•------•------------------;- BUILDING PERMIT ISSUED •,._ ------------�-------------- ----------------;---------------------- DATE ------------------------ ------ Alterations and/or recommendations-------- - ------ ------- -----------------------------------------------•----=: - .�€ - ----------------------------------- --- _ _ e��, -� -----&------ �� ---�_l `- --`-- --------- -------- • ----------- -----� '- - ` ___________________________________ ff, /f�/ °,,,,'+ • c+de -'' '�--yG ��3a fir ..�.----------- ------------ --------- f te'ria, .--- G FIN WSPEG`zTION BY:...�.._ ._.w.l"E4 .. Date------------------ ------------- fiAN OAQUIN LAC L HEALTH DISTRI s C q17� , F y o/ 1 4 South American Street a 300 West Oak +reef �"� 132 Sycamore Street 014 North "C";Sfreet Stockton, California Lodi, California Manteca, California Tracy, California 11-1.ATWOO. 12-54 1 �- 1 # r