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APPLICATION FOR SANITATION PERMIT Permit No. ... z SC...� .. (Complete in Duplicate) Date 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 mode in compliance with County Ordinance No. 549. pjze'ole4l�- JOB AQQRESS AND OCATION.. _ f.t..c: st.,:. ..ffi!�) t..r!:.4.............. ............................... ..... .yah.::... Owner's N��ajj�� ✓L�lx'�Is.!/...�.c..t `:J.rs�.e�x�nJ -',,� � phone._........................... .. Address..1�"2.... z�.. ii j..s j;' ...'f �.(...,f%.: tf.r.;: ^........ .............................................. ...i. .... .......... Contractor's Name.................................. `.✓'.; ..-.. .. ..�.tett.t.4' .................................... Phone..,, �.n..,"jfl.'�.... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail ourt ❑ Motel ❑ Other Number of living units: ......_ Number of bedrooms ....... Number ojj:taths2...... Lot size .�� ,�... Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table S� ft. Character of soil to a depth of 3 feet: Send❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe Hardpan❑ Previous Application Madc: Yes ❑ No [ New Construction: Yes Er-N'o ❑ FHA/VA,Yes❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Solc T k: Distance from nearest wrsll.��r..:.tDistance from foundation....la. ..._Mate tel..............:.. /��f��......... No. of compartments......c7_� ..........S4e..5Z .C7.....-..Liquid depth...�,,ll.t ...Capacity.,4�..e.... S Disposal F' Distance from nearest well/Q C' .. Distance from foundation.�...........Distance to nearest lot line................ U Number of lines......... . . p�Length of each line.....%?.40................Width of trench...?.. Type of filter material...,r. Q tl&Depth of filter material....,./.f(.�'....Total length....................... -••••••••• Seepage it: Distance to.nearest well/,'f. Y...Distance_from f ndation.�........ . .._Distance to nearest lot line............. ' ., — r Number of pits f lining meferial.,/ e..sZ ..Size: Diameter.....,u..3 ........Depth...c�..J..................... Cesspool: Distance from nearest wnll.............,_Distance from foundation.. ...............Lining materiel.................................... ❑ Size: Diameter............. ... ...................Depth....................................................Liquid Capacity............................gals. Privy: Distance from nearest well...... ..........................................Distance from nearest building.......................................... ❑ Distance to nearest lot line. ...................................._................................................ .... Remodeling and/or repairing (describe):.... .ftfi%iE�.t ......A.1-iMA....... .....F.QK.... ......... e .................._................................................................... I hereby certify that I have prepared this application and that the wol. will be done in accordance with San Joaquin County ordinances, WoL.,s, end rulos andregulations of the Sen Joaquin Local Health District. (Slgned)...... 1:.1.:f... 1..�,.... .....a�J�........... .� ................................ . . . Owner and/or Contractor) 1 By:..................... J '.Gf(�f/, ' .1tt�...................(Title)....�t ........................................... ......................................................... (Plot plan, showing size of lot, location of system in relafion to/t Is, buildings, etc, can be placed on reverse side). _ FOR DEPARTMENT USE ONLY �l APPLICATION ACCEPTED BY... TF- v ........ DATE....... ................... REVIEWEDBY.......................... ... DATE........................................................... BUILDING PERMIT ISSUED...................... ..�...................................... DATE....................................D.. Alterations and/or recommendefions: """""' ........ ... ...... .. .. ,�Q-r.........B 1✓I�y......T.x.:. .............3.....��-.. ............::.........................:::::...........::::........•-•":::: o.... ..... Da .. . ... .................. . .. . /.. .......... .... te -.1.. (�' .... ... _ ...... FINAL INSPECTION -BY.e!11�L r7 1� .� •• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wolf Oei: Street 132 Sycamere Street 514 North "C"Street Stockton, Glif�rei• Lodi. CeCfornie Manteca, Catilorai■ Tracy, CoMomis y _11-7kA 14v4.o 1 57 F PC()()