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�11 ' • � APPLICATION FOR SANITATION PERMIT Permit No. .....7.2_q 1. (Complete in Duplicate) 7 Date Issued Applica;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..54,9- 7,g-4 JOB ADDRESS AND LOCATION-- -------------- /-- Owner's aName .fJ. � ��;��------- A_7_7 _`-I-E.L D- - - -- --------------------------------------- Address--------- -------------------------------------Address--------- .......R-0_s�? —-----4-A-1v --------------------------- Contractor's Name'= _11 = =`:--------- __------------- Phone........---•------------ Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _. Number of baths �- Lot size 1/11-1?---.fl_,_l__�517_--------------------- Water _--.----------. --Water Supply: Public system [❑ Community system ❑ Private UK Depth to Water Table ___(U014-jib L.a e/V Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam y Loam ❑ ClaY7❑� Adobe t—Hardpan ❑ Previous Application Made: Yes ❑µ No New Construction,. Yes ❑ No,0 TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if p1011 r sewer is available within 200 feet.) !. / /� Septic Tank: Distance from nearest well,_.-4?,/___Distance from foundation------ :. Material-[,.__.------------------------- -----____..------- No. of compartments----- Size____ p 't- p y p y--� ----- -- -- .- .- Liquid de th----�"_-- --- Ca acct .-=----!�o Dis osal Field: Distance from nearest w.ell_J�._ _. ____ Distancrom ffoundatioln_u'._ _� --------Distance to nearest lot line..___.__. Number or` , ? L n th of each line_ 9 I.' = ----Width of trench-,Z Type of filter materiaLj_ _-2 _ pth of filter material_-/_ .`:__...__Total length____. -- 4----------------------- ---- Seepage Pit: Distance to\-neacestr-w+ell .- �____:__ is#an�e #nom Toun ation_________ - bist�ict�t n a�e`s*'lat line:~ ' �` ❑ Number of pifis--------------------Lining material-----------------------Size:.Diameter...-......... ----------Dept h........------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.------------ .--.Lining material__..-_.-______._______________._____. ❑ Size: Diameter-------------------------------------Depth--------- ---------------------------------- ------Liquid Capacity---------------------------gals. Privy: f Distance from nearest well......_____------___------------------------------Distance from nearest building------------.--______.___._____._.__ ❑ Distance to nearest lot line:_- -------------------------------------- ------------------------ .- - . � ' - ---------------------- --------------_ ...... `tRemodelin and/or repairing (describe):07- ; -------------------------------------------------------------------------------------------------'--------- - --` , ---------------------------------------------------------------_-----------------------------------------------_---------------------------_--------------------------------------------------------------_------------------- -; 1 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)------ T. --------------- ----- ------------------------(Owner and/or Contractor) By:-------------- - -----------------------------------------------------------------------------(Title)---------------------------------------------------------- -- (Plot .plan, showing size of lot, location of system in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY-_ --------------------------------------- DATE--------------------- � REVIEWED BY---------------------------------- - .� --------------- ---------------------------- ----- DATE------------I-- ••---- - ------------- t BUILDING PERMIT ISSUED--------------- -: ..-.._----_--_------.1--_-.-_-.1-!-'---`--.-- ----Y---_.-i•:-!-!-r-_---5-?-.-^--=--_---�--�-_. ,._ -- -.-..---E--�-._-D_� A• rT"- pE.-^-'----------�-.---_-'-----..-.-_----'1---�----..---+-�-"rt--f- ---- -------�---_-.- A1terations.and/or recommendatonsr f ------------------------------ --- 0." 1------ S ------------------------------------------`=----------- ------------ tr� -----+ - � - --------- -�---•------ 'i? r��P. ! - .. .- ---1 ----__ I . --------------------------------------------------------- ------------ --------- --------------------------------••-------- FINAL INSPECTION BY:.,,.,_ Date__:;.l �_ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American $tree+ 300 Wes+ Oak Street 132 Sycamore S+ree+ 814 North "C" S+ree+ Stockton, California Lodi, California Manteca, California Tracy, California E5-9 ]45446 wTw... f t