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APPLICATION FOR SANITATION PERMIT Permit No. __.------3--`_---___:._� (Complete in Duplicate) J r /3 Date Issued .' _.-.�-!_-___ �d�/Applica4-ion is hereby made to the San Joaquin Local Health District for a pgrrmit t nstru�and install the work herein escribed.plication is made in compliance with County Ordinance,No 549. s'j , r' JOB ADDRESS AND C/ATTION.... -- Owner's Name___.____ _�.LG�/�7��----• --� • --- -- - • - bane Address µ ------------ ' - -- ------ .- Contractor's Name-------- ---- --- -- -------- -----cz=6----- ---- -- -------•---------------------------------------------- Phone -_,W/-5�0-a=--7 Installation will serve: Residence [L Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �. Number of living units:_____ Number of bedrooms _.;-,�Number of baths ._�__ Lot size ----- ------------------------- Water Supply: Public system RL 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' 2]._Hardpan ❑ Previous Application Made: Yes ❑ Nofig—, New Construction: Yes,EI_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_/02_�istance from foundation----/'11--------MateriaL_._<f_�._/��r��_`=- No. of compartments...... -- .__Size_ __,t' ___Liquid depth....Co-D_...__.-._-_Capacity Disposal Field: Distance from nearest well..,A62 R_D1stance from foundation______A�_.--_..Distance to nearest lot line___.ld______ � Number of lines----------f______________________Length of each line_-____--_-6,0------------Width of trench.__- Type of filter material___/ ./`5n rrg f Depth of filter material.-- /_�__.______..7otal length r Seepage Pit: Distance to nearest well_._ 1V_d-,.z�.Distance from foundati --.hr --------- to nearest lot line__>a_P____ Number of pits--------/-----------Lining material__ C- I Diameter-------- -`.�-Depth_ .. _0-.`___________ 1 Cesspool: Distance from nearest well _______________Distance from foundation___-___--._.--------Lining material-------.._..________._______________- ❑ Size: Diameter------------------------------------Depth--------- ------------------------------------------Liquid Capacity------------------ ---------gals. Priv Distance from nearest well--------------------------------------------------Distance from nearest building -- ❑ Distance to nearest lot line ----- -------- --- ------------ ----------------------•------------- Remodeling and/or repairing (describe):----------------- ----------------------------------------------•------------------------------•----------------------••-------•------------- ---------- _. --••--------•-------------••---------------------- ------- - . -------------------------------------------------------------------------•----------------•- --•--------- - • ----------------- ------------------------------------- ----------------------------------------------------------------------_------------------------------------------------.-------.___-___-________•___..__--_.-.__________________.__._.._ I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws and rules and regulations of the San Joaquin Local Health District. - (Signed)------ -------- -- ------ --------------- -------�3�= L-------(Owner and/or Contractor) SY� � ------------------(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 APPLICATION ACCEPTED BY.............................- - --- --- -------------------- ------------ - ----- DATE------ ... --------- REVIEWED -- __ REVIEWED BY------------ -- --------------- - ---------- -------------------------------------• DATE--------------- BUILDING -------- --- •� BUILDING PERMIT ISSUED ---------- - DATE.. - --- --------- -------- Alterations and/or recommendations-------------- ------------------------------------------------------ -- - - --- --�-- ---------------------- - ---------------------- -------------------------------------------------- -------------------------------------- -------- ---------- -------------- C � -- - ---- '"� ' v � ; 4 -.• ------------ --- ----•----; ----- -- ----------- ---------`--`�-- -- ---------`--�`'------------------------------ ----- ----------- ----- ---- -------------- FINAL INSPECTION BY:----- s ---------------------- Date..... SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M 145446 arwnno 12-54