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APPLICATION FOR SANITATION PERMIT Permit No. ----.�_______1______ (Complete in Duplicate) 5� Date Issued -------_ -_---- -" Applicaa-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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--=---- A3--3 Ra« / = Owner's Name.-_7R-1d--------- 9 Phone----------------------•------------- - -oZ.67--1-? .......f�0d.!. ------------------ ---•-----=---------------------------------------------------------- Address._ _ _ - - - -- - - Contractor's Name---- '-- Rf 5.1--------¢-----'50-1v----------------------------------------------------- -------- Phone-„/a.~.6`_1 °7---- Installation will serve: 'Residence ❑ Apartment House 2Q Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_4c__ Number of bedrooms __ _"" Number of baths __ :__ Lot,size ---h_U---X-_9! _____________________---__-_---__ Water Supply: Public.system Do Community system ❑ Private ❑;Depth to Water Table-------- ft: ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ Previous Application Made: Yes ❑1 No N New Construction: :Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tancg15+YiNlgace from nearest well-_--__----_:___=Distance from foundation--------------------Material--___-___-__-_____________________.___--_____. ❑ G No. of compartments------------------------=Size--•----•-----------------------Liquid depth------------------------ Capacity-•----------- ------ Disposal Field-A`.'.,.U4 jce fro '-nearest 'well_-__________ :Distance from foundation----------------------Distance to nearest lot line................. ❑ . Number of;lines-----------------------------------Length of each line------------------:------------Width of french-------------------------- of filter material-------------------------Depth of fil ----------------_`-----Total length--------------------------------------_.-- Seepage Pit: m Distance to nearest well------- -----------Dist e from foundatio _________________ ' _ Distance to nearest lot line__�___�___-"-- Number of pits___:__..-!-__________Lining mat rial__4°_C_ _R24KSiz Diameter__-.5.3-__--------..Depth._..__sr --------------- Cesspool: Distance from nearest well_________________ istance ndation--------------------Lining material-_._____--_________.____.___________- ❑ Size: Diameter_"____________________________ ::-" --Liquid Capacity gals. ep q p y-------------------------- Privy:- Distance from nearest well---------------------------------------- ------Distance from nearest building-------- ---------------------'---------- ❑ Distance'to nea,;rest lot line-- --- ------------------------------• -- -----------------•-------------------------------------------------------------------- Remodelingand/or repairing (describe):-----------------------------------------------------------------------_...... ----------------------=----------- ---------------- •-------- --------------=-•---------------:---•------------------•------------------------------------------------------------_....------------------•-------------------------------------------------------------------------- --------- ----------- --------------------------------------••---------•-_--------•=---•---------------------------------------------------------•- •--�--------------------------------- ---------------------- t.... t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State IawsT,and rules and regulations of'the San Joaquin Local Health District. , nn , (Signed).. ---� _�1.-�---J-�--- -----IW4------------------------- -------•---------------------------------------------------------------Owner and/or Contractor] ------------------ ----------------------------------(Title) = (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 APPLICATIONACCEPTED BY- ------------------------------------------------------------------------------------• ---=-------�------------------------- DATE-�-T--------....-------------=------------ •------------ REVIEWED BY------------------------ DATE BUILDINGPERMIT ISSUED-----------------------------------------=--------------------------------------------------------- DATE----------- --------------------------------------- Alterations •-- - - Alterationsand/or recommendations--------------- ---------- ------------------------------•---=--------------------------,-•------•--•---- ----------------- -•----------- ------------------------------------------------------------------------------------------- ------------------•-------------------- ---------------------------- ------------- "-----------------•------- f _ FINAL INSPECTION BY:_'-......._� -------------------------------- Date +moi_--- 5 ,::SAN JOAQUIN LOCAL HEALTH DISTRICT M 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 Revised W-2100