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0 r-.v NJ 4 h APPLICATION FOR SANITATION PERMIT Permit No-1 (Complete in Duplicate)) may, ` Date Issued --`/ 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 LOCATIO -- oZ-- -�- -- .�I Owner's Name--. -----------------L T=� k one J Address �1 - ------ -- - 1 ` € K• uu ,.-/--------------------------- ------------ •- ------------- 1 �� { Contractor's Name---- -------------�t`�'-Q----- - - - -•--- ------------ ---•----•----------••-----•-•--------------- Phone_ _ '_.? /A Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other D Number of living units: _ - Number of bedroomsNumber of baths --/-- Lot size ----.._.--.__------.---_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/6. ft_ Character of soil to a dep#h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam I] Clay [] Adobe Hardpan [] Previous Application Made: Yes No PP ❑ R'-'-New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t• Tank: Distance from nearest well-------- ---------Distance from foundation--------------------Material__----_-- ----.---_--__-- v/ No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity Disposal Pield: Distance from nearest well-3.57-/____Distance from foundation-_-!F'S---------Distance to nearest lot line----/10[� _ --. { Length of each line-_----70-----------------Width of trench___�_V'1-----_.-� Number ar lines----------�--- ---- ----------- ------ --- i Type of filter maferial._2NF$;-'?R410epth of filter material....... 4_.........Total length-------%�-`-------------------- 4 Seepage Pit: Distance to nearest well_--------------------Distance from foundation------------------..Distance to nearest lot line----------------- 1771 --- -----_❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------,Depth------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-___-------------___-----.----_---. � --- -----------Depth-------------- - -----------------Liquid Capacity----------------------------gals. ❑ Size: Diameter--------------------- --------------- Privy: Distance from nearest well------------------_-----------------------------Distance from nearest building_------------------------------- ❑ Distance to nearest lot line----------------- --------------------' ------------------------------------------------ •,5 Cdr Remode€Ing and/or repairing (describe)----------------------------------- ----------------_--___----- ---------------------------------------•---•---------•--------------------------------•--------------------------•---------------------•----- ---------------------------•----------------------------------------------•-----------------------------------------------•-------------------------- --•-- Y� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaq uin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 2_4 _42 (Signed) - ---------------- ""�¢..'---- --- ------------------------------------------ = - --( wner and/or Contractor) r '' rr By:. -'_-L,U..- Title w - ( - ----------- (Plat plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be Placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ ------ DATE---- ---- .— REVIEWED BY------------------------------------------------------- ----- - -- ------------------------ -------------------- ------- DATE `- �• - - - BUILDING PERMIT ISSUED--------------------------------------- ------- -=---------------------•------ ----------------------- DATE----------------- Alterations an r reg. m en tions:------------------------- - '_--__ ��- ---- .: - s - -� -- ------ --•---------------- ---------- ----------- ---------------- -- ----------- FINAL INSPECTION BY: Date------- - -/--•� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street.,- Stockton, California Lodi, California Manteca, California Tracy, California ,r E5-9-2M ' 145446 ATWOUP 12-5n 1