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AlkAPPLICATION FOR SANITATION PERMIT Permit No. _-- Q__�z--_ (Complete in Duplicate) Date Issued --- Applicaa-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. /'Q ► � +, �v 706 ADDRESS AN L CA�TION..--_ - - '/ ----eA�7`--- R�Y1--..®/'c---�IQ�' y( Owner's Name---�___v___- e.....W/4--- Phone =, �_7 ------------------- ---- // 1P-a/. ----------- Address. --------------- Contractor's Name ---------- /�C�S1�1� /✓C PhoneP { __ � Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: lf- ----- Number of bedrooms_-_ Number of baths I-----Lot size _�S� ��-r_//,S `� -------------------- Water Supply: Public system Kms, Community system❑` Private [] "Depth to Water Table.&S.—ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑``:Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: YesNo ❑ ` 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__f7 Distance from foci dation---1Q----.-_-.Material----- --_-__- - IR No. of compartments...-�. _----------Size 5 (� hp,----- depth__>. �...------------Capacity_.�DO_61?9/1,... Disposal Field: Distance from nearest well./749t-if—Distance from foundation_- 21 ------...Distance to nearest lot line---5,.'r----- Number of lines--- _s__Length' of each line--- ---__F�-----.-.Width of trench_X_.---• f�__--_-._ ` N Type or filter materiaL�-$__-'�0. :._Depth of filter material----- --___---.Total length-----C90-- J Seepage Pit: Distance to nearest well_e.. __1 -!'4L.__Distance fr-om f ndation__ or Q .___.Distance to nearest lot line- --------- Q b4. Number of pits.-Ch's-------Lining material._-Size: Dia mete Cesspool: Distance from nearest well-__----.__----_ Distance from foundation----------- --------Lining material-------------------------- ❑ Size: Diameter-------------------------- Depth L._ -----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well......-----------------------------`y-�------------Distance from nearest building------------------__ ❑ Distance to nearest lot line -----`---------- ------------------------- ---------- ---------------•----------------------- Remodeling and/or repairing (describe):--_--- J ------------ -- -- -•-------- -----•--•-------------------------•----------- I-------- -- -• ----- - ---- - -- ----- --------------- ---------------------•-------------•----------•-----•---------------------------=------------"---- -----•----------------------- --------------- ------------------------------------------------ I hereby certify that I have epar d this applicati n and#ha+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and gulations of a San Joaquin Local Health District. (Signed)----------------------------------- - ---- - w 1 -.(Oer an or Contractor n 6y:---------------•------------- =- -t. --.-. ` - - -- --------(Title)------ (Plot pian, showing size of I / ca ion of system in relation +o ells, buildings, etc., can be plat on reverse sidee). C FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.R__-.-.___... _---_------- DATE_.'r A BUILDING PERMIT ISSUED. ---- -------------------------------------------------- DATE---------- Alterations and/or recommendations:------------------------- _. _ ------ � a •----------- -------- I ,fx ----- -----------------'----- ----^---` ------- ------_----• ---------- -------------------- - t ' --------------`-- = ----------------------------------- ---7- --- .. -.- y ---------------- ------------------------------------------------------------------------ -----------------------------•-•------------------- --------------- - ------------------------------ FINAL INSPECTION BY:----- -------•4------ - - _j-,`-- ----------------- 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 ` E5-9-2M 145446 ATWQCD 1Z-54 •� 5