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a APPLICATION FOR SANITATION PERMIT Permit No. ..-- (Complete in Duplicate) Date Issued� X-��- 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 made in compliance with County Ordinance No 549. //�� JOB ADDRESS AND LOCATION-4 41,Q /7��D�a ----------------- 0. ------------- --------- �_at'_c � q---------��- Ia --h � ------- Phone----- Owner s Name------------------------- !�/ --��.`e�.�------- - ----------- - � -`�------ Address------------------------------------------------t5 1._Z...--- ------ ----------------------------------------------------•--••----- ----- ---------------------------- Contractor's Name------------------------— +.-i s-h------- C '-----------------,---------------------------------------------•--- Phone--3/:77572-------- Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms �_ Number of baths ._�.:_ Lot size ___�-9 y-r --- - ---------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rg Hardpan ❑ a Previous Application Made: Yes ❑ No 9j New Construction: Yes$ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _. Septic Tank: Distance from neariesr/w�ell-r/.W_R-_Distance from foundation___o69--__.__.Matg��al__� �------ ------------- tf of compartments_�j--------------------Size-a'1%--x�--�---�- Liquid depth----------------Capacity-- ---'- --- `�\ � � �.f r 1 Disposal Field: Distance from nearest we!I_.�C1B_--_-_.Distance from foundation_.®___-._..Distance to nearest lot line___.___---- Number of lines---------/_------.____�__�- Length of•each line-10 _.______________ Width of french_j_-.4�'_`_ a."eK Type of filter material__l41�_'�G/f___ _Depth of filter material______��_____Total length___.______,�C_ Q" e-y�-_. Seepage Pit: Distance to nearest well_10EQ -------_-Distance fr m found /(�ation_ _r__.-_.Distance to nearest lot line__.Si.--.----__ N' Number of pits.._.----------------Lining material -_____.Size: Diameter__A5`�.......Depth__2_4y_'________________ ( Cesspool: Distance from nearest well---------------_-Distance from foundation--------------------Lining material------------------------------------- f ❑ Size: Diameter--'-----------------------------------Depth--------------------------------------------- -----Liquid Capacity.- -------------------L--gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line--------------- -------------------------------------------------------------------------------------------------------------------------- Remodeling -------------------------- -Remodeling and/or repairing (describe)-----------------------------------------------------•-•----------------------------------------------------------------------------------------------- -. , ------------------------------------------------------------------------ •-------------------------------------- I -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby c if that I have pr pared this application and that the work will be done in accordance with Sart Joaquin County ordinances, St to aws, and ules a d regulations of the San Joaquin Lo I Health District. (Signed}--------•rla,_��LA--------' -----------------------prelaflion - ------------ - -------------------------------------- {� Contractor) ------ ---- ..,,,}} By:-------------------------------------------------------------------- ----------------(Title)-----�it,stY-YX-kqlO�---------------- (Piot plan, showing size of lot, location of system o wells, buil ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________________________ _____-_ DATE-------- REVIEWEDBY------------------------------ ---------------------------------------•- ----------------------------=--------- DATE---•-------•-------•--------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------ ------ ---------------------••------------------------•--•-------------------•---- •-------------------------------------------------- ---- ----------------------••-------------------------------- - � _---------------------------- ------------------------------------------ ----------------------------------------------------------------------.-------------------------------------- ----- -------- --- - -------------------- ----- -- - -- - - - -- -- -- - - - -- -- - FINAL INSPECTION 'BY:--------- +f "------------ ------ Date---------- _ _/_,_5-- JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--4-2M 90-52 Revised W-2100