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3 Permit No ---'-•7-- ------ 6APPLICATION FOR SANITATION PERMIT _ " (Complete in Duplicate) Date Issued A 'pli , ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ascribed. Thisapplication is made in compliance with County Ordinance No. 549, PP _7.- "-r, -ASi�I_!_I~i --- -------•-----------•--------•--------- ----- -- --- JOB ADDRESS AND LOCATION.___. . _ _ rPhone.---- ---------- 5- Owner's Name----------------------------- R_U ------ Q 4.LS Q - - Address-------------------- -------------------=------ Q------Z........ Phone------ -0.7 ----- Contractor's Name------------------------------- i4� _L -------- ------------------- =- �� f. Installation will serve: Residence 0� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: _PY-- Number of bedrooms .-- Number of baths -___ __ Lot size --- - --------------- Water Supply: Public sys m � ommunity system ❑ Private ❑ Depth to Water Table A,499ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ } Previous Application Made: Yes ❑ No%.. New Construction: Yes ❑ No ❑ �- -� } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' f __ ___ Septic Tank: Distance from nearest well_ Distance from foundation---�--Q__------_.MaterialMfl�-�--- .- --- ` `pyC " _ uicl de th. -r i�Capacity.--f ze. Liq P. � No. of compartments---.2t_'--.---- Si lll.�, Disposal Field: Distance from nearest well � .Distance from o ndation---------------------Q'sstance to nearest lot line_________________ ------- ❑ Number of lines------------------=----------- Type ---- r -----Length of each line------------------------------Width of trench---- -------------------------• QC Type of filter material-------#--------=--.-,_-D.epth,Of,.filter material-----------.-----------Total length----------------------------------- �y a .� 4 1\i Seepage Pit: Distance to nearest well-.40AF--------Distance from foundation.__1_� ___._--_.Distance to nearest t li Number of pits.---- -----------�_Lining material__ k��---- Size: Diamefier._ - ��--------Depth.__- , Cesspool: D+stance from nearest well-----------------Distance from foundation#-__._.._...__-__..Lining material__.___._.________..___.---.--------- (�j I #-----------------Liquid Capacity---------------------------gals.. ll ❑ Size: Diameter-------------------------------------Depth--- ----=' "------- - - - Distance from nearest.well_______ -- "--------------------Distancta.frbin nearest building_---.------------------------------------ Privy: - e w- ---------- I y '� -- ------------ ------. _-----------------•-------------------------- ❑ Distance to nea"rbst loft line-.._ s -------- Remodeling and/or repairing describe}:------:---.4_ , -- ;-------- --------_- -----------••------- --------------------------------------------------------•--•---------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law nd rules nd re I tions of the San Joaquin Local Health District. o r � ---.( ontractor) ----Aa,% -------------------------•----------- - ------ - -- (Signed)•----------•----_--- dim? ------ --------- TitleBY= = 1 (Plot plan, showing size of lot, location of system in relati to wells, buildin , etc., can be pla ed on reverse side). FOR DE -------------------- PARTMENT USE ONLY APPLICATION ACCEPTED BY---i_- —-------- ----- DATE. --- ----- (-0---4:--- . DATE---- REVIEWED 3Y-----------------•------------------ -- ------------------------------ - - ------------- BUILDING PERMIT ISSUED------------------------------•-----------------------------•-- ----- -------- --------------•--- DATE---------- - ------------ ------------------------------------------- --- -- ------------•--------- Alterations and/or recommendations------------------------------------------ - --•-•---------------•------•---- - ------------------------------ ------------------------ ` ------ Date.------- - ------------ ------------------------------------- - FINAL INSPECTION BY:----------�AA)Ao-'=---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street � 130 South American Street ` Lodi, California Manteca, California Tracy, California Stockton, California f -;---2M ;o-s2 Revised W-2100