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" Permit Na. � . APPLICATION FOR SANITATION PERMIT -----.:.- (Complete in Duplicate) f [� b Date Issued Applica-%n is hereby made to the San Joaquin Local Health District for a permit to construct tall the work herein described. This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION------`Sc G ..... ---------�,a� '21 y Owner's Name - -- ---------- ------------- Phone---Al -k-71- ---- Address--- la ----- ------------------------------------- --••------- -------------------------------------------------------------------- Contractor's Name______ ___., ..... __ ______________________ Phone__ Installation will serve: Residence Mo-�Aartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: __l_._ Number of bedrooms -_;?— Number of baths Lot size ----- Water Supply: Public system 2--community system ❑ Private R. .Depth to Water Table VA ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: Yes ❑ Nc,.O�-New Construction: Yes 9�--_Nl ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Septic Tapk: Distance from nearest w �r1 �Distan from foundation_ �_-___._.Magi I___i_--_-_-._--___ __________ _ [r No. of compartments------------- - ------- Size_ ----Xyp_.,;II��`"�Liquid depth . ----------Capacity-- ----- ----- r Disposal Field: Distance from nearest weli��-Distance from foundation_____ ______Disfiance to nearest lot line________ ----- _ � [� Number of knes___.__ 1_____________I_ `l Length of each line____ _.___ ..-_r_____...Width of trench_._. y______________________ Type of filter materia1_S'A-----!..._Depth of filter material__, "*_________Total length---------7S---------------------- Seep�a,ge/�.it: Distance to nearest wellDistance from fo ndation___-1� _ __.__.Distance to nearest lot line... Lam" Number of pits_.-./____._ :Lining 'material_ ___ _.. _`-�.5ize: Diameter----- ----Depth------- S__--______________ Cesspool: Distance from nearest well{_______________Distance from foundation.__----------------.Lining material___-______-__.____-__--____.__-_._-. ❑ Size: Diameter-------------------[ ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._____..__________-__________.__--____-_ ❑ Distance to nearest lot line Remodeling and/or repairing (describe):___..— _.__ ------------------------------------------------------------------------------•-------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------ ------------------------------------- --------------------------------- 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. (Signed(------ ------ ------ C��_ ---------------------------- (Own e and/or Contractor By--------- - — --------------(Title) (Plot plan, showing size of lot, location of syfern in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----64-t-_ "! DATE- . /- ,,� � . REVIEWEDBY------------------------- -------- ------ -------------------- - ------------------ ------------- DATE---------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.------•---- ------------------------ Alterations and/or recommendations:---------------------------- ---------------------------------------------------------------------------------------------------------------------_----------- -------------------------------•------------------------------------------------------------------ -- ----------------------------------------------------------------•-----------••------------------------------------------ --------------------------------------------------------- -- -------- ----------------------------------------------------------------------------- --------------------------------_-----_---------•---------------.----•- ------------------------------------------------------------------------- ------- --- ------- •--------------------------------.-------------------------------------------------------------------------------------------- v � /� /L — SL FINAL INSPECTION BY: ---- ------------------------------ 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-4-2M Revised W-2100