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APPLICATION FOR SANITATION PERMIT Permit No. 1_S (Complete in Duplicate) Date issued -��1?_�,�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and Inst 11 the work herein described. This application is made in compliance with County Ordinance No. 549. 2t_ �1�B ADDr.Jr4� f Z I tg JOB ADORES AND ATIO ._ --- -,F,- " 7 Q 4�� --•---------• ---- - "? -------- -------------------------------------------- f3�• �,,j1(�„ Owner's:Name -- t ------- n -- -------•------------ ---------------------------- Address Phone --------------------------------- Contract or's ------••---•---• - - Contractor's Name --------- -------------- --------•....- r --- --1 1--------..rte�,_ _ Q--- •----------- Phone � ® � Installation wiR serve: Reside ce j`""��`--------•----•------.- [i]-Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: --- Number Number of bedrooms __Number of baths _,r__- Lot size _-! 4 Water Su I Public system � - - "_-)C•1-D-`r�--� PP Y' Y ❑ Community system Y ❑ Private De;��oam h er Table� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 25/�lew Construction: Yes Ug._< ❑ TYPE OF: INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubic sewer is available within 200 feet.) r Septic Tank: Msfance from nearest well Distance from foundation_.-`� _.Material__._.__._ ":_ ___ ` �_ - No. of compartments__- '------- -.- Size_--- _Liquid depth-.�Q fir " �� -------- --Capacity--r.�--�� ' �� Disposalie d: Distance from nearest well - ---_-Distance from ou ation__._/-1 "....... �_Distance to nearest lot line_____. �1 Number of lines-----�"-- _ -- - __-- Length of each line-----/_ __. - idth of trench__-�--�!'�� Type of filter materia .__ ` Depth of filter materral.___1 ." Total length__"" -----" Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line 10 Cess❑pooh" Distance from Number of tsnearest well Distance material--. --------------- Diameter__..---'-------------.Depth--------------------------------- from foundation--------------------Lining material El -------------------- ~ Size: Diameter----- ------------ ------- -- ------- Depth------------------- Liquid Capacity----------------------------gals. I Privy: Distance from nearest vdelL.______---_"---------------------------------__Distance from nearest building----------__----------" ❑ " Distance to nearest lot line___.____. - ------------------------------------------------------ ------- Remodeling �1/or repairing describe - _ .w ------------------ .gA....... . _ _.._ :. ^�!:-_______ .4- .�_Z_{��___ :_¢^?6w Vi=i_____________•--_ --__ -- ---- --------r1 ------------ ---- -- ----------------------------------------------------------- -------------------------------------------------------- ---------- 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. DAY& NIGHT (Signed) ... ,n. ---------------Septic-Tc=k"St;r Septic ------------ ---------- ' 1206 So. Eldorado HO 2-704 , --------------• .. Byi._r Strrc;ttn�:i C iii: = } � _ /+ retract - w o4 o or) (Plot plan, showing size of lot, location of system in relation o wells, buildings, c., can be placed on reverse side). ------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED'BY - DAT[=. — BUILDING PERMIT ISSUED ----------- DATE-VW- -------------•------/ ----------•-------------- Alterations and/or recommendations:__._-...._.___._" ------ DATE---- 7----------------- -- ---- -------- -------------------------------- - ------- - ------------------r . '---------------- ------------ ---•---•-------- -------------------------------------------- A z _____"______________________ ___..._.____.__..________.--_____._ _ -----------------------------------_-------___----------_--------_------------------------------- _ FINAL INSPECTION --------------------------------------------- SAN _ ____ ________SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streo+ 300 West Oak Street 132 Sycamore 5trea+ Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 145496 ATW090 12.54