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APPLICATION FOR SANITATION PERMIT Permit No. __tn. __w _•- (Complete in Duplicate) Date Issued ------ _---L�-2.1 _ 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 Ordinance No. 549. JOB ADDRESS AND LOCATION.- Q_. � { �� - 4_Z.��f,!Q-•----•------•---•---•--••-- -- Owner's Name' -_.+_- .{; - - 99II one. ----•------•--- ------- ----------------------------------------------------------------------------- ------------------------------ Contractor's Name- ;__„__, ? -----------..-----•----•---------•-----••--- Phone..------�-l Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �_ Number of bedrooms --e;?.-Number Number of baths -_/--- Lot size ...... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Pl- New Construction: Yes ❑ No M. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ta.nce from nearest well-----------------Distance from foundation_- -----.Material----.___--.._____-___ r' ❑ 0.,1'compartments------------- ----------- --- ----Size-------•--------- ---- - ------.Liquid depth_---------- ---- -- ----CepacitY--------- ------------ Disposal Field: -D;f,t6nce from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--_----.--__„___ ❑ ,. �/� jAbier;W iines--------------- -------------------Length of each line------ Width of trench_._.- Type�filter material----__.-- _ --------- - ------------Depth of filter material------------_---_j-----Total length---------------•-----------------___-•- - Seepag�Pit: Distance f nearest well__1_�`'o .0 Distance from fouriddtion_r__!,P�__.__-.Dis+ancejo nearest lot line--.-- r ® Number of pi+s------ -------------Lining material-----�--( eter---- �-----------Depth-----• _` --------- Cesspool: Distance from nearest well--__----_-_-- S __Distance from foundation--------------------Lining material--_--- __.--- Size: Diameter ------------------Depth--------- ----- d - --------------- ---------- ---Liqui Capacity- .-----------------------.gals. � Privy: Distance from nearest well--.._-------------------------_---- gy _-----Distance from nearest building v El Distance to nearest lot line---------- --------- Remodeling and/or repairing (describe):--------.---------------------------------------------------- ---------- ---------------------------------------------------------I----------------------------------------------------------------------------- -----•----------------- •-----------------------------•----------•--------•-----------------------•-----•-----------•------------•--- ----------------------------------------------------------------------- I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, nd rules and regulations of the San Joaquin Local Health District. (Signed)......... _. ------------------ _ ---- -------- --- --- ------ - --- - - (Owner and/or Contractor) - - ZX �_- (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-------- f --------------- ----------------------------•---------- DATE } REVIEWED BY DATE, C BUILDING PERMIT ISSUED------------`-�__-- ------------------- -------------------------------••----------------------------•----------- DATE Alterations and/or recommendations:_-____________ --------------•-------•--- r -- .------------��------ r ----- ----------------!--------------- FINAL INSPECTION BY:.. Date 1 - - - r- � ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California Ea---9-2m 145446 A7W030 ,z-54