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Z, APPLICATION FOR SANITATION PERMIT Permit No. ,/ `�� (Complete in Duplicate) Date Issued Applical-ion is hereby made to the San Joaquin Local Health District for a pe4nif to construct and!install the work herein described. his application is made in complianceia,with County Ordinance No. 549. J013 ADDRESS AND LOCATION-------- Ll Owner's ........ ------ ---------------------- ------------------- - - -------- ------------ --/ Address---- - __4_r--------------- ------- ------ --- ------T---------------------------------I——------------------------------------------- --------------- - 4 9V PhoneJ-4----- - Contractor's Name------�_tk ------------ --------------------------- ------------------L-------------------------------------------- Phone-A - ------- parment House E] Commercial [] Trailer Court E] Motel Installation will serve: Residence ��=t - m E] Other L] Number of living units: _A--- Number of bedrooms Number of baths A---- Lot size ___-t,t7!q_A 14'_(3 Water Supply. Public system,K21"Community system E] Private [D Depth to Wafer'Table4-, ft. Character of soil to a depth ;f 3-feet: SandE] Giravel ❑ Sandy Loam E] Clay-Lciarn [] ClayE] Adobe Er"'Hardpan E] Previous Application Made: Yes E] No 2rNew Construction: Yes El—No Fj TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifkin'200 fed+.) Septic,16-rik: Distance from nearest well_'______Disfanice from oundaflon-J-P.,..........Material---N%Lg",q� No. of comparfmenfs_:.._:��.......... . ...........I S. - -----Liquid clep�th__.J------ --------Capacity.-S"_I- - ------ f !rl Disposai Field: Distance from nearest well_- .__.__.. Distance from foundation_____--t4t(erk----:Distance to nearest lot line-- - ---------- NLimber of lines-.------[--.---_---- ------- ----Length of each Iine--------S---47 -------Width of trench---- - ------------ Type rench----- Type of filter material._4. .. .........Depth of filter material___._ --------Total length-------so--------------------------- Seepage P& Distance #o-nearest-;velI..'*V�-•---------Distance from joundati;n--- Distance to nearest lot line---' Number of pits------t---------------Lining material---..1t ------ Sze- Diartiet -Size: -----------------------Depth--------;34.4 i ------------------ Cesspool: Distance fi,orn' nearest"well-----------------Disfance from foundation_.;. --------------Wing material----------------- ------------------- El Size: Diameter----------------- ------+-----------Depth----------------- ,-Liqu;d C achy-.------------------------- a -------gals. ririvy:' r T Distance from nearest well--------------------------- ----—-------------:-.-'Distance from nearest building--------7_*-------------------------- Distance to nearest lot Sine_---___-_-_._..____-- f -------------- Remodeling and/or repairing (describe):------- -------- a-------------- ---------- -------------------------------------------------------- ---------------------------------------------------------------------------------------------------- ------------- ------------- ----------------- ------ ------------------------------------------------------- --------------I-------------------------------------------------------------------------I---------------------------------- ----------------------------------------------------------------- -----------( ------- --- --- ------------------------------------ -------- -----------------------------------------------------_----------------- --------- - - --------------------------------------------------------------------------------------------- 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, an'U'rules and regulations of the San Joaquin Local Health District. ...........I--------------------------------------------------------------------- ----------------------------- -- ------Owner and/or Contractor) By:._... "1 �/ buildings, -------- -(Tii (Plot plan, showing size, Mot, Ioc__a_"fi,o__n---01-4-'s system_f_L_'m'---i n----relation t o_w,---eiis......b u--i I d i n g s etc.,__ca-n be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --------- ------•------- - -------------------------------------- DATE----------------•------ rI -------------------------------- - REVIEWED BY---------------------------------------- ---- -------------------- - .... DATE------------------ ------- ----------- BUILDING PERMIT ISSUED --------------------- --- - ------------ ---------------------------------------------- DATE------- ? Alterafions and/or recommendations:-- ------- ---------- - ------------------------------------------------------- -------------------------------------------------------------- )r-----•-----•-••-------------------•------- ------ ------ ------------ ---------------------------------------------------------------- ------------------------------------------------- ------------------------------4-------ir--------- ---------------- r�W----------------------------------------------------- ------------------------------ -------- ----------------------- 45�_ -------- --------- - ------------------------------------------------------------------------ -------------I--------- pk?a---�;" .jq ------------------------------------------ - ---------- ------------------ ............ ---------------------------------------------------------- ------------------------------------------------------ ------------- FINAL INSPECTION Date... ------------------ 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 145446 ATWDOD