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APPLICATION FOR SANITATION PERMIT Permit No. .__17 ....I___V (Complete in Duplicate) Date Issued Aplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and in.stall the work herein described. This application is made in compliance with County Ordinance No. 549. ,D JOB ADDRESS AND LOCATION_ 10 Owner's Name------- --------- '"r------- .. ----------------------- Phone------------------------------------ Address-----------P,_o............ _---------------5.'a..s---------------------- _ --k.........Ife9_41J.;--------------------------------------- ----------0,"g,,1 5 C., �&i Contractor's Name_ -------- ---------c- ---- -----------------I--------------- Phone-Al Installation will serve: Residence 13--Apartment House E] Commercial [-] Trailer Court [-] Motel [] Other E] Number of living unifs: -/--- Number of bedrooms__5__ Number of baths Z---- Lot size ------- Water Supply: Public,sysfem El 'Community system C]' Private J:R-Pepth to Water Table,67- 7 ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loan! E] Clay Loam 0 Clay El Adobe 2 Hardpan El Previous Application Made: Yes E]I No 9- New Construction: Yes RL No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiffed if public sewer is available within 200 feet.) p Septic Tank: Distance from nearest well---- Distance from fougdation------/40'_ __..MaferiaI----40-4�� .14 0 --------------------------------- No. of compartments--------1�---------------size---------- -----------Liquid clepth--------40-"" ,.$r 7-W ...___Ca ----------------------- Disposal Field: Distance from nearest well---------------..-Distance from foundation--------------------Distance to nearest lot line-______....._____ ❑ ine---------- ------ ElNumber of lines-_--------------------------------Length of each line------.---.--.--------- ._.Width of trench.------------------'---------"""_-- Type rench----------------- ------------------ Type of filter material-------------------------Depth of filter material------------- -------Total length------------------------------------------ Seepage Pit: Distance to nearest well--------------------Distance fro foundation..___14---- Distance to nearest lot iine------;�, rn. --------- 1A Number of pits----------/---------Lining material Diameter_""."- Depth-----=ZQ-115-7 ----------- Cesspool: Distance from nearest well-----------------Distance from foundation----- --------------Lining material_"..---_.____..._-_._________-____. El Size: Diameter.--#-------------------------------- Depth-------------- --------------------------_- 1 _--Liquid Capacity_-----------------_-------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building-------------------•---------------------. ❑ Distance uilding------------------------------------------ Distance to nearest lot line--------------------------- Remodelin ine----------------------------Remodeling and/or re airing (describe ------ -:�---- ------/__6--------TZ)----------6--e-R-u-c---------------- of-y- - -------------------- ------------------- - jo------------- 9_4ff-------------------- -------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- -----------------------------------------------------I-------11---------------------------------------------------------------------------------------------------------- ------------------------------------------------------ I hereby certify-that I have prepared this application and that the work will-6e done in accordance with San Joaquin County ordinances, State_JaW-F,'>and rules and regulations of the San Joaquin Local Health District. I I - - (Signed) --------------- - ---------- --- -------------- ---------------- 4S.,—------------ --------------------(Owner and/or Contractor) ---------- - ----- ------ By:.... ---- - ---------- ------- ----------r-------------------- -- --------------- (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 APPLICATION ACCEPTED BY---- ---------------- ------------ -'------------------------------I--------- DATE --------- REVIEWED BY------------------------- -- ----- -- -------------------- - --- --------------- -------------- ------------ DATE BUILDING PERMIT ISSUED-----------I--------------------------------------------------------------------------------------- DATE----- Alterations ATE-----Alterations and/or recommendaf ions.* -- -------------- ---------------------- ---------------------------- t ----- ---------------------------------------------- ---•---•--r--------"----------- ------OU, '------i --------( -- ----------- ---------------------i-------------------------------------------------*-----------------------------------------11-11------I------------------- - - --_---------------- - -------------------------------------------- ------------------------------------------- ----------------------------------------------------- ------------------------------------- .........I------------------------------- -------------------------------------- -------------- ---------------------------------------------------------------- .............-1------------------- ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- I � -�< FINAL INSPECTION BY:-'-'-- ------------------------ --- - ------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street L 300 West Oak Street 132 Sycarniore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California 145446 ATWr]MD