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APPLICATION FOR SANITATION PERMIT Permit No. .-1C111Z.. (Complete in Duplicate) Date Issued -_��!/�5K--- Applica4ion 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. 2S3 _ f?,e Z,3 JOB ADDRESSAN LOCATION ___ _ - l a \ ---- -- --- -------- � �----1 _ Owner's Name-__ -- - ---•• --• •--- -• ----••- ---q•--�----------------- -�--••----- -------------- - ----------------------- ---- - - ---- Phone ----------•-�--�� Address v...- l � 1= C--------------- t -••---------------- ------------------------•--•-----------------....------------------------------------- Contractor's Name----------•-------- -------- ----- Phone --••--------- Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑, Other ❑ Number of living units: ___I___ Number of bedrooms _,P•!_ Number of baths ___L Lot size _ 4 Z - -------- ----------------------- Water Supply: Public system ❑ Community system ❑ Private,I Depth to Water Table ._�_ Character of soil to a depth of 3 fee+: Sand ❑ Gravel [� Sandy Loam Clay Loam ❑ Cay Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r 1�fic Tank: istance from nearest well �1_�Distant? from nd ion__-_ Material_j�/ � AjNo. of compartments-----------p -_-.----Size_ -- --- -----`Liquid depth-----.4:�--344-----Capacity------9'��'�--•- _1 Disposa I Field: Distance from nearest well--_'2,Q&1�Distance from foundation___/-, ------Distance to nearest lot line--- Number -_Number of lines_-_______/_.-... Length of each line-----�U.___------ __Width of trench__._ Type or filter material-J. Depth of filter material �?__(�- ..... _ �f.. Total length___.___ -----_--___ --------------- ) (17, Seepage Pit: Distance to nearest well...9_Q-Q`F__Distance from foundation___,[ .___ D' t nce to nearest lot line.... Number of pits-____. __._____-- =�rx mateRie/lr n. - Size: Diameter..-.. ___, Depth_._ Cesspool: Distance from nearest well-----------------D1Lom foundation._..----.----------Lining material--------------- ❑ Size: Diameter---- ------------------------ - -----Depth-------------------------- .----- --------- - ------Liquid Capacity-.-------------------------- . Privy: Distance from nearest well--_............................______-____-----Distance from nearest building------- -__.._____--x__ _ r ❑ Distance to nearest lot line ` Remodeling and/or repairing (describe)--------------------------------------- ----------------••----------------•----------------------------------- ----------------------------------------- -------------------------------------------------------------------------------------------------------------------- ----------•-------------••---------------•----------..._..----------------•---•----------------------•---•----------••-------------•---------------•------------•------------ ---------------------------------------------- -----------------------------•------•-------•-- ------•------------------------•-------------------•------------------•-•------------•----------------------------------•-----------------------•------------•--- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules regulations of the!San Joaquin Local Health District. (Signed)------ ------ s ! - ------------------------------------------ -----.(Owner and/or Contractor) By -----•--------------------•---------•------------------------------------------------------•-------------------------------------(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----------.- REVIEWEDBY--------------------------------------------- ----------- 1 TMJ- --- --•-- ---------------._._ DATE------- BUILDING PERMIT ISSUED-------------------------------------- / !' DATE d '� /�< ;------------- _----------------- Alterations and/or recommendations:---------------- - --------------------- ------ ---- - ---------------------------------------- ------------------------- ---- -- ----------•--------- --------------------------------- ---------•------ ---------------------------- ----------------------- - X, -------- ----------•-----------------------------------------------------------------------------•-------------------------- FINAL INSPECTION BY: ------ --- Date Cy 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 ES-9 145446 ATWppo