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" APPLICATION FOR SANITATION PERMIT Permit No. ..f..._3..._3 (Complete in Duplicate) / Data Issued ..�.�./...�� Application 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 LOCATION............../-`/......_.. (�. .L�.. ... .... .... .. ...... Owner's Name................ ... - 2AyX2'et`�: --------...... ---... Phone_................................ Address.............-................................ ..... ..................... Contractor's Name..................... ...... ................ - ........ - ............. Phone.-................. .__.....-- Installation will serve: Residence ^ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.... Num r-5f-bedrooms . . Number of baths .1.. Lot size ........................ .................................. *- Water Supply: Public system Commu .�.. _ nifyjsystem ❑ Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0_J1ardpa..Lr ❑ Previous Application Made: Yes ❑' No ew Construction: Yes [g--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted ifpublie sewer is.aveilable within 200 feet.) i . Septic Tank: Distance from nearest well-MV-PM. ..-Distance L!e_Distance from found�}ion....�1�?, .: .. atenel.... �e�.�...�R -.'. �S pp,,11 No. of compartments....I.. ...........Size....t .�........Liquid Disposal Field: Distance from nearest well.W."_k e.Distance from foundation......14.... _Distance to nearest�llo-t''line._._. 1' Number of lines........ .......i...�_j. ..�.._ Length of each line---.....7 .. ....rWidth of trench....' Type of filter material,��. r ypntL..:Depth of filter material....`. '....jl...--Total length........_��......................... Seepage Pit: Distance to nearest well.......... from found'atioxl...................Distance to nearest lot line........... 1 ❑ Number of pits......................Lining material_____..__.._--_--,,._.Size: Diameter;._._. .. ._. Depth______.. , Cesspool: Distance from nearest well.................Distance from foun .........Lining material_.....------------------------------- . ❑ Size: Diameter.....................................Depth................?--- ........VM-- Liquid Capacity...........................gals. Privy: Distance from nearest well.......................................�}:....Distance from nearest building..............__._...........---_.____.-- ❑ Distance to nearest lot line.------..................................... ------------------------------------- Remodeling - �- ... Remodeling end/or repairing describe ....__.._..t.._L.�J,2 Q,P..... t --_-_ --�{ -------_ ll Ems! ........ . - ..... .................................................... ----------...............__. D-F -•-•- - - ---------------------...... ............-------......------ - -------------------•---------------------------------------------- - t I hereby certify that I have prepared this application and that the work will bli=done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health * riot. (Signed/� -.- k- 1x1 R-ss .........-..........?f`.:.....................- . _(Owner and/or Contractor) By:...................... - ---------------__-----_---------------_--------------------------------------------------_-__'._.(Title)........ -- -- ----------- _...............— - (Plot plan, showing size of lot, location of system in relafion to wells, buildings, eft.,ran be placed on reverse side). to a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....................... -- --------------------------------------_......_. ..... DATE:. ........... REVIEWEDBY---.........................------.........--------- - ......---------- ................ ---•----........ DATE'--•-r_•-----......---................................ BUILDINGPERMIT ISSUED---........... .......................................-__................................. DATE-.............................. ........_................. Alterations and/or recommendations:......---------•...............----•-----.........__................_........_...........-•----------------•-----------....---------------- -•--------------.........-.......-.-•-----------------•-------------------------------__...._..•••----•--------....._....................:...............••••••-.-..._..-.............---.............. -----------------..................................------........................... ................................--......................................--................................................... ------•--------------------•...........................................--•-----------................------............................... -------•----........_........ ................__...... .................-...........-.................................................. .............-........................--......._................ .........-......-----.......... --........................ FINAL INSPECTION BY: ......-• •--•................ Date.... -• c/ ---•-------------•-------- - -� SAN JOAQUIN LOCAL HEALTH DISTRICT ,30 South American Street 300 West Oak Street - 132 Sycamore Street 814 North "C'• Street i\Stockton, California Lodi, California Manteca, California Tracy, California