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APPLICATION FOR SANITATION PERMIT Permit No. ....S_iZ..-.......... (Complete in Duplicate) rl Date Issued .......Le3/ Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct an i tall h wo erein described. This application is made in compliance with County Ordinance No. 549. i` (�� JOB ADDRESS AND LOCATION....-..�e \) ,,/ lc v.-_L-Ct.------ Owner's Naamrye- ----- -- - farp._.: N....--'----------'--------- Address xf� ��Li:�,7�J�� - `Tr�.Ca Q. Y�� - -- - - Phone.. - ................. i - - - -�rD- 1-----------.�.-%f---- Contractor's Name..... - 1.f4P.Q.Le't -----elL(�� _. �V/ _� -- ---- Phone. ------`-- --` -'-- Installation will serve: Residence ® E]'Apartment House Commercial E]"Trailer Court Motel ❑ Other Number of living units: /... Number of bedrooms - _ Number of baths �� .- Lot size .-- �_ C]- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table /jP..ft. Character of soil to a depth of 3 feet: Sand Cl Gravel ❑ Sandy Loam ❑ Clay Loam `Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No @9� New Construction: Yes "o ❑ 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_l1'� .-._._Distance from foundati _.l1 r iYL __---- -Material_.. L- •1� No. of compartments_._ on. _- $ize.e; �s.'..1.C_.�F.Q.._--Liquid depth_.-1 Ca acit ...1:'j.G'�1----.. Disposal Field: Distance from neare t well) pa Distance from foundati n..._ Z P y ''FF ' �-_..._.Distance to nearest lot liner -"-�-- t Number of lines..-- --- -- _. Len th of each line_ is // g ��- --- -1_.-_...Width of french.... ____ _______ Type of filter materiall2../F%Zk Depth of filter material__f -..-- g ----Total length .��L'.-�------------ Seepage Pit: Distance to nearest well_..._.---------_...Distance from foundation...............:....Distance to nearest lot line--........ F-1Number of pits_. --------------- Lining material ----- Size Diameter Depth.._ ------- - Cesspool: Distance from nearest well.- .___Distance from foundation - --.---_. Lining material Privy: _.._ -- - - ❑ Size: Diameter------- ---- ---_-----------------Depth..----------�------- -------------------_-----.Liquid Capacity ----------.__gals Distance from nearest well_......- ...- --_---.-Distance from nearest building._. __------__.__-..--_ ❑ Distance to nearest lot line.--`---- -f--�-----------------------------------'----..---- Remodeling and/or repairing (describe):-------- / y� ----------------------- � ------------ ----------- -------.------- i. - - - - ere y 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) ..__.{1`.ti � ------ Jit - ��--------- - _ y��- - -- �: .__...__.____(Owner and/or Contractor) By:.- --------- - ` -�"=G�' -- - ---- ----------- - ---_. ..._(Ti+le)....- - - .. ........ . (Plot plan, showing size of) t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. ::.. ..... ------------ ---'---------------- - _ DATE..................----- - ----- ---- REVIEWEDBY----------------------- -- --.._....._. - ------------------- --- ------------- ....... DATE-M'----------------- ------------------------------- BUILDING PERMIT ISSUED--------_.............. -- - -- ---------- -------------------------- .__ DATE... ,------------ Alterations and/or recommendations:........ ........ -..._.- -- --------------- - -.......---------------------'_'-------------------'--...---------------- r ...-- ---------------- ------------ -- --- ---- ._:..... - - - _,t.. ._._--------------------------- - ------ ------------------------- ----------------- �• - -- - --- - .... ... -- - ----- - --------.------------------ --------------------------- . - ._.......__i..._..._........_.._......_----------------------------____.........._- . .............. ....__ .........____.__.......__._--------.......___. _......._..........._._._..__....- ------------.--------------------------_---..._...___----_Y:..__... FINAL INSPECTION BY._. -------------- Date....1),NJIJ ----.- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California rS g 1454 fi Aiw000