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73- jl� APPLICATION FOR SANITATION PERMIT Permit No. .-7.'_4-- / r, (Complete in Duplicate) Date Issued �.':.�...�..... l 0'7--3�v --03 Applin+ion is hereby made to the San Joaquin Local Health District for a permit to construct and in sial the work herein described. This application is made in compliance with County Ordinance No. 549. i z Val k _.Z7O.t. K?` rt(C_G4t[G7 � '�r� Y� JOB ADDRESS A rL ATIQN--!t^...L.-Ur�...... . i `1 _�I(: _....... - - - - . rnOwner's Name r - ........ ........-- .. ... . .------......------ -•------... Phone.--------------.........--..... Address.- f..Q_ ... r------'---•---'.......................................--------........-----..._....----•-..................---- ------ ------......................_... Contractor's Name... ---_--.-•--------------------------------•-•----•----....--••--------................................ Phone .............---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other Number of living units: - umber of bedrooms ........ Number of baths...._ Lot size ca.41.�.-4, 7w-........ ...... Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table ........ ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam F Clay ❑ Adobe ❑ Hardpan❑ Previous Application Made: Yes ❑ No M/ New Consf)uction: Yes 20"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 9� (No septic tank or cesspool permitted i r,,ub�llicps�e(w/er is available within 200 feet-)�,,�� Septic Tank: Distance from nearest well.'__�!.!.:Y."":4Jista f o fun tion��._"."=....Mate i �_7-4 p gco r rg (� No. of compartments......_ Zt..��.J/��SizeM...._la�6-K....r.Liquidldapth........�....._..._.Capacity..��r? ..f_..y Disposal Field: Distance from nearest Well�!!f5.....XDistance from foundatignlQ..... ..----Distance to nearest lot limp._ ❑v� Number of lines........... ..... .. -. ...Length of each line�rQj. IWidth offrench..._.!�! --....t........._i" Type of filter materiel 1 (� epth of filter material._...__. .........Total length.::........ ls3.n.-----._..._... Seepage Pit: Distance to nearest well......................Distance from foundation...................Distance to nearest lot line................. ❑ Number of pits......................Lining material.......................Size: Diameter...:.-.................Depth_...__........................ Cesspool: Distance from nearest well........_.......Distance from foundation...:................Lining material..................................... ❑ Size: Diameter............. ...:.................Depth.--------............----- ----....------:Liquid Capacity..............-...-.._...gals. Privy: Distance from neares+ well__.., -..._.......__._........................Distance from nearest-building...................................... ElDistance to nearest lot line.. -------------------•----•-----...._........----............................---_......-...-..............................-........ ( Remodeling and/or re-p.a..i.ring cribe):� ... 0............ --: ::,--j ^-� .......— .. ...... ...... ----............--- . . .......--•----------------.....................................-........................-_...............-...........__......................................................-.............................. ---------------------• . ---------- •---------....--------•-- . ------..........------------................-............................................... ...........................---............................ 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. e k p y� 4 (Signed)_._.... rt. ".__......r/!e ( tL L�iI_. _ ........--.............--. - -. --.Owner end/or Contractor) I. BY:........ 2F .�l.,e!.QQ...... .... y/ trifle)... .,:,_........ - (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, eta, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.'R.. DATE-3 .... -----...._...---.....•—................ REVIEWED BY --�`$;............................-..................------.........----...... -- .... DATE-�......---..._............_.......--•--..... BUILDING PERMIT ISSUED.................... - --......-------- - - / ........... DATE.... ..... Alterations apd/or recom endefj9ns .._d O TL....... t 4+209......T4✓. ......e.A.......r47.. - --- = ------------------------------------------- ---------- ------------------------- ................. , ....... .... ............... --- ----------------------..........................-•-------------.........------------................................ . C1�1..7�7 �. ` FINAL INSPECTION BY:..I/S4ANJOAQUIN . Date.:..._. ..... ...................................... k I LOCAL HEALTH DISTRICT 130 South American Stroll 300 West Oak Street 132 Sycamore Street 814 North "C'• Street Stockton, California Lodi, California Manteca, California Tracy, California