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A� PY APPLICATION FOR SANITATION PERMIT ermit o- ----------------- 1� (Complete in Duplicate) Y: Date Issued .f Ulm 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 �w,ithh County Ordinan e No. 549. JOB ADDRESS AND LOCATION----5-EZ�----r ..: ^'tl� -��-----------------------•---------...-----------...-------------.----_-----•-------------. I Owner's Name--------`�W�------ " -------•--------•---------------------- -- - ------ --- -------------- ------- - Phone------------------------------------ i Address-------------•---------- i .....,cam' .� = . t% F ------- Contractor's Name ------------F ----- � �'` c c - ,•? Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .____ Number of bedrooms _�_.. Number of baths ---L_ Lot size.--,�V'_k/ _.�. -------------------- ' �! s Water Supply: Public system P�'Community system El Private I—] Depthto Water Table T ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E*]--Hardpan ❑ Previous Application Made: Yes ❑ No ( — New Construction: Yes ❑ No P— TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic onk: Distance from nearest well-----------------Distance from foundation-------------------.Material ------.----------.-__-._--.-------------._--_---' "/ fl No. of compartments------- -- ----•-- Size--------------------------------Liquid depth--------------------------Capacity------------------- Disposal Field: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----------------- yNumber of lines-----------------------------------Length of each line-------------------_---.---.Width of trench-------------------_-------------- �-/!J Type of filter material-------------------------Depth of filter material----------------------- length------------------------------------------ Seepage Pit: Distance to nearest well--2WL .__Distance f fou, aizenDi er_ s�nce toDnearest lot line---1/4-- e: ine_�4_- __. Number of pits----- ----------------Lining material . c' p --.-IV-------------- T .....-. ; Cesspool: Distance from nearest well-----------------Distance from foundation.................-. Lining material--.----------.----.-._---__.....__.. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity gals. .\ ' Privy: Distance from nearest well ----------------------------------------------..Distance from nearest building._--._-_--_-_---.---------_-.---.--.-.-. ❑ Distance to nearest lot line----------------- -------- ------------------ =�� ---------------------------------------------------------------------------- rl -- Remodeling and/or repairing (describe).-------------- -- - ��--- - ---- ---------------- -- - -- ----------......--•-•------------------------------- ----------------•--•-------•-......--••---•---•----------------....------••-----------•--------------••----------------------------------- ------------------------------------------------------------------------------------ ---------•--------•--------------------•----.-. ------------- •---•-----------------. ---•--------- -----------•------------------------------------•-------------- ------------------- 1 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 Joaqui Local Health District. Signed) .._.1 } T.'�[ _ -------- - " "1 = � ssdr Contractor) BY� �� (Title ` (Plot pian, showing size of lot, locati n of system in relation to wells, buildings, etc., can be placed on rev side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------- ------- -- ------ DATE----—,-ta\--------- -------------------------------------- REVIEWEDBY------------------------------------- ------- -------- ---- ---- ----------------------------------------------------- DATE----------- ..>----------------------••-------- ...... BUILDING PERMIT ISSUED----------------- -------------- - - ------ DATE----- C� -------------.------- Alterations and/or recommendations----------------------- - --------------------------------•----= ------------------ - ------------------------- --------------------------- ------------------------.-------••------------. r. .. --=--- ---�- fid_ ---------------------------------- -----------------------------•--------------------------------------- FINAL INSPECTION BY:.---- Dater -e--S - --------------------------------- 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 �- E5-4 145446 ATWOOO -