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�s--d APPLICATION FOR SANITATION PERMIT Permit No. z- (Complete in Duplicate) 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 Ordi c No. 49. JOB ADDRESS D LOCATION-----_r-- ° :j �r .+ ---------------•----------------------------------•---------------- Owner's Name_ P t!'-s-----t_¢' __.'4." - - one Address------------• --.=---�� ---=� -'��'__'71•.__4h •t I Contractor's Name•---- --•--- 7 _ 1 --------------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court A. FF ❑ Mot�l ❑ Other!❑ Number of living units: __f-__- Number of bedrooms Number of baths ---L Lot size --•---•-- --•-- -- Water Supply: Public system Community system E] Private ❑ Depth to Water Table -------- ft. ------------------------ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay [:1 Adobe �arcipan ❑ 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 0 Septic Tank: Distance from nearest wel1�4"t�;1 A ___ _._�:,._.,Dista�y� fro ffoun �tioni..l��`�----.Mater•a�____.�_ 'e�1�--�';�`,'� No. of compartments_._._ i _ ' SiV_�- Liquid e th._____- ! p Y 15 Disposal Field: Distance from nearest well�-- .fir#,r Distance fram foundation��---- - - Distance to nearest lot lin _ r ® Number of lines------ ----r - ---- _--Length of each Eine_-- 'f•---------.-- Type of filter ma#eril. _. 4 h Width of trench___._____/_ _ YP r�_Depth of filter material__.__ - f Total length---------- /7 - -- Seep agile Pit; Distance to nearest well______-.a *Distance,f om foundation_______ .-�____. �""~` J Distance to nearest fot line_______ _______• Cess Number of pits.-----:f.-_---------Linin material-- -__- '� Depth--------------•-----f�k--; j 9 _ ,�''-:-. - sue: Diameter. ------x�'-��-. .� � i pool: Distance from nearest well_________________bis#an 'from foundation ------------------ Lining material__._--___._____-__ Size: Diameter-------------------------------------Denth------------------------------------- --------------Liquid Capacity----------------- - ------gals. \ Privy: Distance from nearest well______________________-..________.___- --_ Distance from neares# building g ------ Remodeling ----- ❑ Distance to nearest lot line n.v ---------------- Distance --------------- (V Remodelingand/or repairing Cdescribef:____----- -�'" �1� a . f ' f er 1 � ! ... ----- ..... = "_ .r� � , .--- <: --------------- ---------••- ---------•----------- - --------------------•-•------------------- x ? , ------...-------------- -----------------------------------------•----------------- -----------------------------------------------------------••--- -----------------------------------------•----------------------- 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 regulation' of the San Joaquin Local Health District. (Signed)i....___ ..... Owner and/or Contra -- - ,�----•- --� -ter-- -- ,.-� ----- ----tom a.. By:_-----•---------- /_`,j -----------------------•-------------•-------------f--------------(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__-_ BUILDING PERMIT ISSUED---------- __ - --------------------•---------------------- DATE--- AI er ions and/ race .mendatians:_..__- ---- -------------------------------------------------------- -------------------------------- -------•------------------•---- 7-- _' " ---------•-------------- --------r---11------------ - ----------------------- --------------------------I----------------------------------------------------------------------------------------------- ---------- ---- -- ---------------------- FINAL INSPECTION BY: l ------------- 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 ATWOCO - t�