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APPLICATION FOR 'SANITATION PERMIT Permit No. 3-a..s-__Q. (Complete in Duplicate) Date Issued /—I ( fps— 22-0 —0 3 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 Ordinance No. 549. A.., rr:, kJ JOB ADDRESS AND LOCATION_.- , 4--A------ r,yiC � t,y- w t Owners Name------------ ),,---t:at ------ Phone--------------- Address. ------ Contractor's Name____ 10 ,e- ¢12,1?Vie : 1� ------------------ Phone--- =� Installation will serve: Residence,' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-_-_- Number of bedrooms __Number of baths ___/__ Lot size ___ Q__ _ ---l47_2?_'---------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (' Hardpan ❑ Previous Application Made: Yes p No>Zr_ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) i Q Septic Tank: Distance from nearest well-AVO _Distance f! fo ndation__� _�______.Material---& r _____ ______________•. .. N No. of compartments- ------Size _ Liquid de th__�.`�_ ____-__Ca aci �g f 'r Dispos I Field: Distance from nearest well-A14-0 _IJistanc3from fo ndation____- Distance to nearest lot line____ R;i7____ •' � Number of lines----------------f_ _.__ ____Length of each line__.__l�--__r _ 7----------------of trench----- Type of filter material_____i__�_�r�__Depth of filter material_._---A&-" -----Total length1_d�Q.'____ ___ _______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------_---__- ❑ Number of pits----------------------Lining material---------_-------------Size: Diameter------------------------Depth_-------------------------------- Cesspool: Distance from nearest welL----------------Distance from foundation-----------------.--Lining material-------------------------- _____._-_-- ❑, Size:.Diameter-- -=------ ------ _===�'"'"`4" `-f igliid Capacity-----•--_ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______-_-_________------_________-___-__. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------•---•------•---------------------------------------- -----------------------------------••---------------------------------•--------------- ------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I. ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, at�d rules and regulatioris of the fan Joaquin Local Health District. (SignSi ned _ } Contractor ed) = C- �"-F------------`-�------------------------- ) --------------- ----- $y:----- -- ----- ---------- ---------------------------------------------------------------------------(Title) (Plot plan, sho ing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ----- DATE------------- L�-------------- REVIEWED BY --- ---------------------------------------------------------------------- DATE -, ------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE Alterations and/or recommendations--------------------- ------------------- ------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- ------------------------ ------------------------------------------- - --------------------------------------------------------------- -- --------------------------------------------------------- 4— FINAL INSPECTION BY: --- --------------------------- Date- '� ----------- r 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-9-2M 8-51 Revised W-2f00