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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATI/ON.�._"'Sf _,G.-�_��;1"�.r.}�,..k°i�• -L-.:"• ••- -'--�•- ` Owner's Name.------------`-1,% 1_-_...... --- --- --• ---- Pho e..-..:.x ,. .. r+• -------- -------• _4'��.4��......------ � -- ------:� - y ----- - --------- Address.. � « r ♦ �� - -_ ...' � ..'' � P one yy� Contractors Name..,...w.�•�--.�-. ._.•---- ----- h -'T_��_.__ u Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer'Court'❑ Motel ❑ Other ❑ ;Number of living units: .__._. er of bedrooms ___.. Number.of baths,:._._ Lot size _ � ..-_ .- •• ----.v. .- Water Supply-- Public system Community system ❑ Private [] Depth to Water T! i Character of soil to atdepth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam❑ Loam ❑ Clsy ❑ Adoba at'clpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: YestT No ❑ TYPE dF INSTALLATION AND SPECIFICATIONS: j (No sap is tank or cesspool permitted if public sew r is available within 200 feet.) 1 Septic Ta h� Distance from nearest well//A. �....Distance from foundation_.-1.---!-_.Mat ri -_-� -----------------LS- Liquid depth ?� CapacityZ10-a-0, leo. of compartments-.,,2.-•-•---.--_-.._. e__--------............. Ca aci1!' i Disposal F' sf: Distance from near st wellh��-._Dis+ance from =ourdation__ ___ Distance to nearest lot-line--,,5 __..__ Len -h or` each line__... .._.Width of trench----_-_ Number of lines_. e' ..t..:.._.._ g. �- Q--- � --• • Type.of filter material-�X_. __ Depth of filter material.... . ..........Total length---------p"_a:_________...-...... Seepage Distance to neare��st,,,,,wnell, Q .. ___ Dis+ante from f ndation__1 7_ __Distance to nearest loft line...�.- Number of pits.(�114.i........Lining material_&M Diameter..;_.j_--_----Dcpth..-..� ---------- V --- -...._. Cesspool Distance from nearest well.................Distance from fo dation_.-.._.....__.......Lining material...._...._.._. :..�c:.:',...._:. ❑; Size: Diameter------ `3 �- ::.....Depth---.r--_+:.- �-' ' .:Liquid Capacity-----------------•---_--gals, t k 1 i Privy:' D:stance from nearest ----------------•--- =••---- ---.....Dis-ance from nearest build'ing.........----------------------_ ' Distance to nearest lot line....____f_ -4- _ Remodeling and/or repairing (descri ��1 ___ .�._....-.-. -- •----._....-• --..-- •--- - .. .. _ .__._.... ..........---•---------•• __._._..-----------•-• -- -•---• ............. ------- - ""�` • - I .. . -0------------ ---•--R- '�---.-- •-----. ----------`-----_.-.-•------------------_.._.-_..---------------- ----------------------.----------------------------------------------}....------_...... . r . I hereby certifythaf I have prepared this application and that the work will be done'in accordance-with Sart Joaquin County ordinances, Stat awl, d rules a d re lations of the San Joaquin Loc#I Health istrict. t L .e!G'C�......(Own. andfo rrtraefor) (Signed}------------ -�----- ----�..... (BY:. Mtle)----- 1= -------------- (Plot 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.----.--.. REVIEWED BY. - t '"-•-- -------- DATE..........................................._—_ BUILDINGPERMIT ISSUED.------.. :...........................---................._.-....... DATE...............,. .�._:...:_..... Alterations and/or recommendations: ..................................... •-•---:- ....... ......... ........ _ ...» ..................... ... .. _-.._......_......._... ..... .....-.-_.--••----------- -- FINALINSPECTION BY:..-._...... _v Date_._. SAN JOAQUIN LOCAL HEALTH DISTRICT 134 56vtb American Streaf 360 West Oak Street 131 Sycamore Street' 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, Califemia ~' ES---9-2M: - Revised W=.;fCQO ````+-