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I APPLICATION FOR SANITATION PERMIT Permit No. - J7 0. ( ompel C te in Duplicate) qq 04 Date Issued --- A -f ��.5 -3 < � ++ T, Application is hereby made to the San Joaquin Local Health District for a permit to nstr:f idlinsta114e work herein described. This application is made in compliance with County Ordinance No. 549. '� JOB ADDRESS AND LOCATION-_ _.O--Q- � 1 -.�?Y' LL --------------------------------------------- Owner's Name__.---•-4-601*--ra1-----..Ck-V--Z-------•------------------------------------- ---... Phone----r---14�?`� q - -- --- -- Address------- � ContractorsName------------5AK-'-v-------------------------------------------------------------------------------------------------------------- Phone----- --_�"�' y p ❑ ❑ Trailer Court ❑ Motel/❑ Other ! Installation will serve: Residence Apartment House Commercial ❑ Number of living units: -1----- Number of bedrooms �_._ Number of baths __,�____ Lot size __-_--_%0- __-----�--7a----------------- Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes 14 No ❑ New Construction: Yes ' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-kl6_n-P_Dista ce from f un ation_-_-__--_a_-r__..Material---�_efh *PC,-/(°'r_"-��_e�_�x 34 No. of compartments-----")..................Size6-'.K56,P,_fX,�--- !Akiquid depth--S--- ----�--------CapacitY-- ----- Disposal Field: Distance from nearest well_6 V.0-Distance from foundation_--�1-6--5--.__-Distance to nearest lot li e---��-----------0 to Number or lines____-3________________________Length of each lined_ 3___ IS _ Width of trench -L 4 g t��- .--- -- - -?------------------- Type of filter material__ ------- Depth of filter material---- ----_---Total length--_____.. - Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------.__-Distance to nearest lot line---------------- (� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth---------------------- j J ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_____--._________---___.- Size: Diameter--------------------------------------Depth---------------------------------------- ---------Liquid Capacity-.-,•-------•------ --------gals. Privy: Distance from nearest well______________________ _________--.-.--____.__-Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------- _____________________________________________________________________________________________________________________________------------------------------------------------ --------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)g )----aO-'l /�f d - �--------------��.- ---------------------- -------- -----..........................................................- ------(Owner and/or Contractor)- By:------------------------------------------------------------------------------------------------------------------------------------Tale � (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------ W-1-- -----'-�-j--• =-----•------•.-.- DATE------ !!` -- - -- --------------------- T ----------------- REV I WED BY---------------------------------------------A--------------- ------------------------------------- ------------- ---------- DATE-------------------- -- -- ----------------------- UILDIN PERMIT ISSUED------------------------------------------------------------------- ---------------------------------- DATE -- ---------------------------- Alterations and/or recommendations_______________________ _ - - ------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- --------•----------- ------•---------------------------------- --------------------- --------------------- -- ------------------------------------ FINAL INSPECTION BY:.---------- - .: -------- - 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 E5-9-2M 10.52 Revised W-2140