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APPLICATION FOR SANITATION PERMIT Permit No. ......... Date (Complete in Duplicate) p Date Issued / /./.,S_3 Application is are y made to the San Joaquin Local Health District for a permit to construct and instal[the I t herein t This application ' ade in compliahce with County Ordinance No. 549. i�^ .c�CSS'T` JOB ADDRESS AN O lON_' -A--- J�JF_--�F �� C----- --2tPx-LFIA..--- --111 ----•. Owner's Name------ --- -------------------------- ------ -------------- Phonej- /(D�_Z------•-•--- - ------- ----------- it Address , f}- E------------ Contractor's Name--- ------• ---, .. _L, _ ----- --- 'at �j a -�¢�- ------------------------------ Phone---- `� lP07---- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court Ot r ❑ Motel ❑ Other ❑ + Number of living units: Q- Number of bedrooms A/2. Number of baths -1._-- Lot size !L�.-_X +!p Water Supply; Public system ❑ Community system ------------------------ Character - pP y' Y Y ❑ Private [� Depth to Water Table rS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ C[a Loam Clay Previous Application Made: Yes ❑ No 9 New Construction: Yes p< No ❑ Y ❑ ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ___1 (No septic tank or cesspool pe-rmi}ted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-, -� Distance from foundation_--y__ __ _. �I�j+( Material--____ _ No. of compartments_.,Z "---- ,S lo" ,'�p"I'i '� Size • Liquid depth_ , ?J - Capacrty- —-----. A Disposal-Field: Distance from nearestwell.- _�___Distance from foundation____L#-�_-- i Distance to nearest lot line- -.----__ Number of lines`_---- -- n Length of each line-- ..�---- - -- 4"• Width of trench ----- -- - Type or filter ma*eriaL --------------------- --- �L"X—Depth of`filter material--- - _______Total length-------. �,�"_ Seepage Pit: Distance to nearest well_-- Q ______pistance rom foundation___- �__ !y ' j+r j - D'st�r,,ce to nearest lot line-1.1, Number of pits_.-._�-.--_ �/ Lining material-------1'l_ -.Size: Diameter- ' ----__--_-Depth-{_Q_�----------------- ,Cesspool: Distance from nearest well----------------Distance from foundation----_---------------------- -�---• Linin ❑ Size: Diameter- - Dg material ------------------------------------ Privy: --- - --------------- p ------------------------- --------- --- ------Liquid Capacity--- -----------------------gals.sancerom nearest well----------------------------------- -----_ - Distance from nearest buildin ❑ Distance to nearest lot line------ g ------ Remodeling and/or repairing (describe[____ _ _______ ------------- ------------------- - - - ------- ° ------ -- k Q 9�Llf` �1 .� � j I I hereby certify t ve p tired this a plication and thaat,the w�k will be done in accordance with San Joaquin County ordinances, State law , and ules d regulati sof the San Joaquin Local Health District. +� (Signed)----••------------------- 21-------------- (Owner fn dr Cant actor) sr• -------------�' f - Tale- [Plot plan, showing size of lot, lova ion of system in relation to wells, ru;lTdgs, etc., can be place n reverse side. ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----._---.--�.-__--_ DATE REVIEWED BY-------------------------------- ----------- -- C BUILDING PERMIT ISSUED DATE - -* � s and/or recommendation :---'----------------- DATE -------------------- Alterations FINAL INSPECTION BY-- ----------- - _ �-"'"• Date-- �►" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 914 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100