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-z " APPLICATION FOR SANITATION PERMIT Permit No. __.. _._ ---3--25, (Complete in Duplicate) �,/ Dater Issued _�_'l -A Application is hereby made,to the San Joaquin Local Health District for a permit to construct and i he�,,,o Kz!n described. This application is made in compliance with County Ordinan No. 549. J08 ADDRESS AND L CATION_______ _____7 --I-k � R _5 -1 Owner's Name---------- - ---.----- Phone--------- Address.------------ •---�.�...I �. --1_� G�i-1�.i.�- �--�----•---------- --- ------------- ------------------------ -------------_ Contractor's Name--------- ----- - - 1.5_ - — — ---------••---------- --•--- Phone_- Installation will serve: Residence [ Apartment House F] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _j--- Number of bedrooms _-2-- Number of baths/ Lot size __-_6.4 Water Supply: Public system RLCommunity system ❑ Private ❑ Depth to Water Table _R0ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClaY Loam ❑ Clay ❑ Adobe Hardpan [] *' Previous Application Made: Yes p No ( New Construction: Yes P� No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank D. nearest well-----------------Distance from foundation__.__-_________ .Material-___________________ _ No. of c artments --------- ---Size----••------------------ ------Liquid depth--------------------------Capacity----- ----------------- XDisposal Field: Distance from nearest well-,/]C pistance from foundation__/Q--r.......Distance to nearest lot line___ AA''�� Number of lines-------.f------- , Q r� Lep fi.h,of each line_ o ." Width of trench - Type or filter material__.I�____, � th of filter materiaL_r_�------_- --.Total len th___.__ :. g --•---------------_-- \1 o nearest well_-(Q�pistance from fo nd�tion___.. D- Total to nearest lot line_---moo eepage Pit: Distance to pits_________ ___________Lining material._�,�.� Diameter_--___ Dumber o - .�. _.._Depth ....�-,�-----�---------- Cesspool: Distance from nearest well-______'_..___-_Distance from foundation ._ ----Lining material------- ---------------------------- ❑ Size: Diameter- ----------------------- ---------Depth----------------------------- ------Liquid Capacity-------------------- gals. Privy: Distance from nearest 'veli---------------------------------------------....Distance from nearest building Distance to nearest lot line-------- Remodeling and/or repairing {describe): -' ( �GG ,.- o r __ ________________________________________________________________ ____________________________________________i__----------------- ----------------------------------------.________------------------------------------------------------ __.__. _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State , and rules and regulations of the San Joaquin Local Health District: (Signll + } ---•-••------- -------- (Owner and/or Contractor) By:.... p,c.. -----.(Title)-----:-- --- ___ _________ of 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 -5 REVIEWED BY ------ --- _ ------------------------------ - ------ DATE-------- --- ---•------------- --- ----- ---- BUILDING PERMIT ISSUED.---- ------------ --------------------------••---- -------------------- DATE.._.- --��---- Alterations and/ recomme ati ns:__ ___._ -------------------------------------------------- ..------- �r ----•----------- ------------------------------------------------- F1NAL INSPECTION BY:, Date.... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americen Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street { Stockton, California Lodi, California Manteca, California Tracy, California E ca_9 145446 ATWODD