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�b1 APPLICATION FOR SANITATION PERMIT Permit No. d_ G_._ <br /> (Complete in Duplicate) <br /> Date Issued �� <br /> •2zv zS J� - H r 6-Aq WAY 2G = <br /> Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. d Q� cj p ZS <br /> JOB ADDRESS AND LOCATION----- fl- i7 . � ---- <br /> Owner's Name.------. _..._.. ------------------------------------------ ----- ------------------------------- Phone------------------------------------ <br /> Address---- <br /> -----------------------------------Address------------- --=---------1�- --- -t 6-4--A---- � L �.1 r1...._._ ..... <br /> ---------------------------------- <br /> Contractor's Name-------- 1� -------------- ----------- ------ ------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House E] Commercial F] Trailer Court E] Motel F Other [•-� d rr <br /> Number of living units: -------- Number of bedrooms -------- Number of baths &-:_ Lot size ___,(,g_e-J' ----------/ 6 4: B2 <br /> Water Supply: Public system ❑ Community system ❑ Private P?-9e­pth-to Wafer Table Ss ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [P- Clay ❑ Adobe❑ Hardpan ❑ h� <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publicsewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---_L (1-- Distance from_foundation----!4__._.__.Materiai___ _C___ ' - <br /> [j�� No. of compartments------�---------------SizeJ�`'_6__ 6'F - ---Liquid depth----j3------------- Capacity_ --_r----�- m <br /> _Ca acit ----------- <br /> Dispose F* Distance from nearest weil___v`'..�_..._Distance from foundation________ .___ Distance to nearest lot line---- <br /> Ek' <br /> ___ <br /> E Number of lines------ .-V---------Jr------Length of each ---Width of trench._.___.__- --"_____________ <br /> Type of filter material------/.15----&Depth of filter maferiaL__.._L__ _'�-_Total length-----------74----___________________ <br /> SeepagP/Pit: Distance to nearest well..y4_V_./---Distance from foundation_____/__ ___�_ Distance to nearest lot <br /> [ Number of pits--------- —-------Lining mate ria i _ ize: Diameter___ - . -----Depth..__._s` •S� -_________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------.____---__-_._________________- <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well .....................___-____.__._._.__._..._._Distance from nearest building---------------------------------------- _. <br /> ❑ Distance to nearest lot line----------------- ---------- - ------------------•------------------- ------------------------------•------------------------ ------------- <br /> Remodeling and/or repairing (describe):--------- i_X---�rL -------- Y ----------------------------•-••--•-•------•---------------•-------- <br /> ----------------------------------------------------------------------------•--------------------------------------•---•---•-•------------------•-----------------------------------•--------------------------------------- <br /> -------------------------- --------------- ----------------------------------------------------------------------------------------------------------------------------------------•..--------•---------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws]and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---------------t1 <br /> �� = �- -•s ------ -------...--------- --------------------------- {Owner and/or Contractor) <br /> By:---•------ ---------------(Title)---�� °--------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --------- ---------- ------ ------------------------------------------------------- DATE------ ------------ <br /> REVIEWEDBY------------------- ----------------------- ------ ---------------------------- -------------------------------------- DAT -- ---- <br /> BUILDING PERMIT ISSUED--------------------- :____-_ -_-- -- DATE-----..---- --------- -------------------------------- <br /> Alterations and/or recommendations:- -------- ---------- - -------------------------------------------------------------------- <br /> --- <br /> - - ---------------------- <br /> ------------- <br /> ---- .. � - : :-- - ------------------ . . ---------------- --•------------------- --------------------------------•-- --------- <br /> --------------------�---------- --- -------------- .------------�.-------------- ---------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------- ------------ --------------------------------------------------------------------------- -----------•-------. -- ----------------­-- <br /> FINAL <br /> -------------- --FINAL INSPECTION BY:_ _ ------------ Date....jd._'_41-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> es—s 145446 nrwnno <br />