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1INT APPLICATION FOR SANITATION PERMIT Permit 'No. (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health D- r'icf for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc o. 549, JOB ADDRESS AND LOCATPN..____- ____ ---------- --- --------------------- - ----------------- Owner's Name------_-- ------ ---- K ---------- -- -- ----- 6 ---------- -I------------------------------------- Phone----- kAddres - ---- - - ------------ ------------------L----------------------- i-------------------------------------------I---------------------- !Co'ntractor's Name________________ --- ------------------------------------------------------------ Phone--.3, Installation,will-serve: Residence Apartment House ❑ Commercial [:] Trailer Court ❑ Motel ❑ 'Other ❑ o/ Number of livi�_g_unK Numberofbedrooms-- of baths /---- Lott size 4 ----------- ------------ Wafer Supply: Public *system Community system ❑[I Private ❑Li .tiJ Depth to Water Tabl� ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam L) Clay Lci-am E] Clay El Adobe Hardpan E] Previous Application'Made: Yes n NO New Construction: Ye No E] TYPE OF INSTALLATION AND SPECIFICATIONS: *12 (No,septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank--3 Distance from nearest w61-,,7-L-pr'-__Disfa e fr m foundation-- -------Mat ___Capacj y---- --- t No. of compartmenfsx,--f—------- ----------Size-:? --Liquid clepth__ x N ---- ------ Disfrom nearest well___.--._.__.___Distance from foundation----- __Distance to nearest lot line-!_____..____.._. p s+ance _ + y Number o f,lines-----------------------------------Length of each line-s _------- WidW- of french Type of filter material-------------------- ----Depth of filer material-----------.-.------..Total 'length------------------- --------------- -we A--%, `\ -1---------------------- Seepc it: Distance 10 nearest jell------)1*-,_A,_Distance from foundation /!P---------Dist ./ L .4 grice to nearest lot line--8�--------- C� N,'mber of- ------ ---- I ... j ! I - r --------- �7ts_ i ing maiferial--a-.1�' --------Size: Diamete ------ Depth - 1-Lin v�7 ....... ......... Cesspool: Distance.,1from.. nearest well--------------.--Distance from foundation.- ---------Lining material___ __- --_.__ ___- -_____ e: Diamete'r\ �------------------------------:----Depth----------------- -------- ----- --- -----Liquid,Capacity...................... 0als. Privy: Distance from nearest well__________________________________.._______- ----Distance from nearest building------------------------------ ---------- El Distance to nearest'lof lire------------ --------- --------- ----------------41 ------------ Remodeling d a�-- -------------- -- r r6pairing (describe):------ ------- - - - ---------- -- ------------- ---------------------------- 2------I---------------- ---- ------------ --------------------- ----------------------- ---------------------------------- ------------ ------------- ----- ----------•------"--- ---------- I t ----------------------- --------- --------------------------- --------- I ereby certify that I have prepared this applicaifion and that the work will be done in accordance with San Joaquin County ordinances, SYa"N laws; a, 7 r !as and regulations 0-f the' San Joaquin Local Health District. (Signed)_ - ------ ----7-------------------------------------- ---------- Sy:----------------_ ------ --- ----(Owner-and/or Contractor) �71----- ------ --------------------By:----------------_ ---- --------------------------------------------- � Tale -------------------------------------------- (Plot plan, ordinances, si moflotjocation of system in relafion to wells', buildings, etc., can be/ aced n reverse side). FOR DEPARTMENT USE ONLY i N------------ --------- -- ---------------------------- --- DATE__.-�! APPLICATION ACCEPTED BY -- --------------------------------------------------i--- DATE BY--------------I - .... -------------- --------------- BUILDING PERMIT ISSUED----------------------------------------------------- - := ZZ---------------------------**---------------*------ Alterations and/or recommendations:.---- - -------------- - --------------------------------------- DATE---------- ------------------------ ----------------------- --- ----------------------------------------------------------------------------- ------------------------------------------- ---------------------------- --------- ---------------------------------------------- ----------••--------------- --------------- --------------------- --------- --------------------------------------------------- ------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------I------------------I,- t - i -------------I---------------- ------------------------ --------------------------------- ---------------------------------------- --------------------------------------------------------I--------_------------------------------------------------------- ---------------------------------------- - -------------------------- -------------- ------- ------------_------------------------- ------- ------------------- -------------------------------------------------------- FINAL INSPECTION Date.......6 --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreot 014 North "C" Street Stockton, California Lodi, California k Manteca, California Tracy, California Es�_9_zm 145446 A7WQCD 12-54