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APPLICATION FOR SANITATION PERMIT Permit No. ---- -- �' (Complete in Duplicate) 1 Date Issued NG______,I Applica+ion is,hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applica ion is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO .------46_�df�/------------rS -------- ' •-------------------------- -------------- Owner's Name-------- SzI ,OP,--•-L' _15nvz -------- Phone. --• i Address---------------------- .So= -- ----- ---------61r')_.JAL-�-�`,�------•4-1y-•--------------•-•--------- Contractor's Name---- _-. e4f aii�/ - ooqJ. i /vC�- Phone-/ v4-- 9_ P--7 ---------------------------- Installation will serve: Residence impartment House ❑ Commercial ❑ Trailer Court ❑ Motel L] Other p Number of living units: -------- Number of bedrooms --4 Number of baths ----e- Lot size -_�O_-- _ ....X,-_-_-�S-C-' •- ---- -----•---------•- Water Supply: Public system [,Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand-❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ug�ardpan ❑ Previous Application Made: Yes ❑ No Uj,—New Construction: Yes ❑ No [+4— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well-MM41 Distance from foundation,3_&`____-_Material__. No. of of compartments--------- Size= -X__�---_F_6-,_--Liquid depth----s [a......-------.-Capacity-- 'd-Q---------- +� Disposal Field: Distance from nearest wel44a/�__Distance from foundation---35 /---....Distance to nearest lot line.-.P-a'.___ t Number of lines------- __ _ --- _ Length of each line----------- _- _-_---P,c ".��._. Width of trench--____ ''�.--- I Type or filter material P. of filter material-------- 0--------Tota[ length------PA_a!--_-- _ --- ------------- Seepage Pit; Distance to nearest well_-.1.�/kfl/L�_Distan om foun n--_ d_.�__ Distance to nearest lot line__ b�___- Number of pits.-..--_�----.-------Lining mat real-,�!"-t`CK_-Size Diameter----- _��__--.Depth--_--.mss'!------------ at ------- - ((�� Cesspool: Distance from nearest well-----------------Dir n afion.--_- -_---- Lining material-------------------------------------- ('\} ❑ Size: Diameter--- ------ --------------------- ----Depth------ --------------------•-- ---------------------Liquid Capacity----------------------------gals. Q Privy: Distance from nearest well________________________ Distance from nearest building ------------------------------ ----------- ❑ Distance to nearest lot line- ----------------- --- ----- ---=----- -•------------------• -- Remodeling and/or repairing (describe)------------------------------------------------------------------- ---- ---------••---------•----------•---------------------------------------------•-----------------------•------------ --------------------------------------------------------------- ---------------------------------------------•----•---------- ------•------------------------------------------- ---------------I-------- ------------------------------------------•-------------------- -----------------------------------------------------------------------------------------------------------------I hereby-certify that.I_have-prepared4his-application-and-that-the work-will-be done-in`accordanie with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- ' J SH-- - 7 --- --------- ( caner and/or Contractor) ---------------------------- By:. ---------------[Ti ocafie) , • ---- ------------------------- , tion of system o wellsbuildings,in relation t , gs, etc., can be placed on reverse side). [Plot plan, showing size of lot l FOR DEPARTMENT USE ONLY ------------------------------ APPLICATION ACCEPTED BY------------!-------- ------------------ - ..--------- DATE------ -�e - ------------------------------------------- ------------- - ----------------- ----------- --- .....�-.-...----------------•------.- REVIEWED BY --. DATE-------------- -�_- - ------ --------- -------------------------------- BUILDING PERMIT ISSUED---------- ---------------------------- --- --- - -----•----------------------------------------- DATE Alterations and/or ---------------------------------------- -----------------_Z------------------------- recom end tions------------------- ...- --- --- �� '` — ---------- --------------------------------------------------------------------- ----- - -------------------- -------------------------------------------- -------------------- -------------------------------------------------------------- ------------------------- ------------------- ----- - -- ------------------------ --------- -----------------------------------------------------I---------------------------------------------------------------- ------------------------------------------- ------------------•-------------------- ------ - -------------------------------------------------------------- --------- - - - ----------------------------------------------------------------- FINAL INSPECTION BY:.. --- ------------ --------------- Date---- �---- --------- 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-9-2M 145445 ATWOOO 12-54