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i APPLICATION FOR SANITATION PERMIT ......Permit No. _... _.P__ (Complete in Duplicate) 1 zz - Date Issued _____ �U Ili 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. i� / r ,106 ADDRESS A OCATI - _. "�`" ' 'G .=...--- Owners Name ------•- •----------------------- -------------------------------------------- Pho ` .. Address.........../ . -- --•-- -------------- -f Contractor's Name... .... ---------------- Phone _�n , Installation`will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot er ❑ 11 ! Number of living units: _j___ Number of bedrooms ...L Number of baths __4-___ Lot size ___"J- _0_�t____!__ ___ _____________________________ Water Supply: Public system ElCommunity system ❑ Private ' Depth to Water Table Character of soil to a depth"of 3 feet:- Sand ❑' Gravel E] Sandy Loam [-] Clay Loam E] Clay El Adobe Hardpan E] Previous Application Made: iYes ❑ No;K1New Construction: Yes N0 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' 7 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) u P 7"�41'i-X-_. __Liquid� .th_.M }�I.._-..-- Capacity_- .. .._... Septic Tank: Distance"!from nearest well__ -.Distant f founda� _ pe�r� No, of com artments______�______ _Size-.__.__-__. 1 - -------- Number from nearest�well� ____-_Distance from foundation______;._.Distance to nearest lot Ii Disposal Field: f hnes__-,I---------------- Length of each line • ' r _..._., .Width of trench___-_� Type or' filter material-_ ref)epth of filter mafer•ial___�� -_Total len gth___._.__.___ V............... Seepage Pit: Distancei;lto nearest well---------------------- from foundation___...__..______....Distance to nearest lot cine_________________ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter.-_.-------------------Depth--------------------------------- Cesspool: Distance'�from nearest well-----------------Distance from foundation------------------- Lining material---.-__-____--___..._______________.. ❑ Size: Diameter------------- Depth----------------------------------------------------Liquid Ca acit ---------- -----__ als. ---------- ----------- y. ..�,�,. .. :�._.,.� ay—.�_- tri Priv Distance from nearest well---_-------------------------------------------__Distance from nearest building__..________.___________.1-.__-_--------- ❑ I Distance''to nearest lot line--- - - - ------------------------------f----------------------------------•-- ------------------------------------------------------------- Remodeling and/or repairinglJ (describe:____- _ ___`_ -_- ' ----+ --------------- •------------------•------ -----------•---- {� --� I hereby certify'that I have prepared.this:application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an&regulations of the San Joaquin Local Health District. (Signed)-! - (Owner and/or Contractor) ----------------------------------------------------------- By: -------•--------•----------------------------------- B :._...---••-----.._. ---------------------------- Title -------------- (Plot #f plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ;L -,� FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY---- ---------------------- - -----..------------------------------------ ------ DATE REVEWED BY - M DATE_ ��/ ...� ._ - ---------=----------- BU --- BUILDING NG PERMIT ISSUED ;;y DATE ----------------------------- Alterations and/or recommendations:.__.___.__..__ __._ .. -_ ,1 it ----•--- --------------- -------------- ---------------------------------'------- ----- r 6 FINAL INSPECTION BY:.y� J Date------1-2 ------ -1�i;;5 - I SAN JOAQUIN LOCAL HEALTH DISTRICT it - 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California �` Lodi, California Manteca, California Tracy, California E."-.----8 x45446 AT-D Ip