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APPLICATION FOR SANITATION PERMIT Permit No. _. 7_}`- (Complete in Duplicate) Date Issued -----___-------------- Application 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 Or nce No. 544. D JOB ADDRESS AND LOCATION 1------f-d-0-6-.- Q _�_�1' `._._ _C.fJ'L------------------------------------------------------ Owner's --------------------------------------- �-------- Owner's Name------44-ow-ol-{:74-•-----2-a-L-b------------------------------------------- ------- Phone-------------------- Address-------•----------------- b-m-co----------------------------------- ---- ------------------------------------------------------- ---------------------------------------------- Contractor's Name--- y.-4 -.[-l�f�/ ------ ------------------------------------------ Phone- ---a--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1----- Number of bedrooms ---1" Number of baths .-/-- Lot size ----. !tea ' -------------- Water Supply: Public system eCommunity system ❑ Private ❑ Depth to Water Table 4�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er- Hardpan Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se -- Distance from nearest well_________________Distance from foundation------------.-------Material--.-_----._-.--_._.--_____-___-----..-_-----.--. No. of compartments------------- - ---------Size-------------------------------Liquids epth--------------------- ---.Capacity----------------------- p I F' Id: Distance from nearest weli_/VChA_.-Distance from foundation.____________.Distance to nearest lot line__-S__-------- Number of lines-------E _... ----Length of each line__��FJ .....-----.Width of trench-----1"1. lekType of filter material Depth of filter material---- -.dotal length_______________________________f_I_ ,/ Seepage t: Distance to nearestwell- ilk-S,-------Distant rom foundation-_- ---------Distance to nearest lot li __ ________ Number of pits..-._,----------------Lining material_ 5----_..Size: Diameter_--�- .........Deptn___.� 7 ____-------------- 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. DAY& NIGHT ad r Contractor) Si ned [ 9 )--- ---------------Septic- -Servicer----------------- ---- - ----- By.*-. • --• 1205 So. Eldorado HO 2-7048_._________ [Title}_ 4 ' BY: } - - (Plot plan, showing size of lot f ca and o �Voem in relation to ells, building , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- _ -- DATE-1-------------------------------•------------------- REVIEWEDBY--------------------------------- DATE--;-�-------------------------•-----•------------------- BUILDING PERMIT ISSUED - DATES_-_---------------------------------------- Alterations and/or recommendations-------- ------- ------ -- --- ---- ---------- - -----•-•----------------------- -------------------------------------- ----------------------------------------------- -------- --- ---------------- J --------------------------------------------------- ------------------------------------------------------- / .. ------------------------------ FINAL INSPECTION BY:-_'____ f. ,--c --- -• -----�--------------- bate----------- ------------ 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--9—.?M 145446 arwona iz-sa