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APPLICATION FOR SANITATION PERMIT Permit No. ....,1._,.LJV . ,. (Complete in buplicate) J�I M t Date Issued _l..2-'A 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 incompliance with County Ordinance No.549, it JOB ADDRESS AND CATION_--�5/A -'V1'..;...r !! ? -.�F`K.c.r'c.S(•• •Ce : /� OwnersName. ••-..•--.. .. _..._._.. .._......._�.... ........._....................................................Phone.........._...................__ • . l Address..._».... �....... .....a.�d�(a... __....._. _....: ......_......r.. ........---.:.__..._._..__...._................_---.._....._...-•---..._.._.. , Contractor's Name....... .__. _. ._.. _.. .: C. . .. ._ .�............. Phone....................._... .. Installation will serve: Residence's Apartment House❑ Commercial ❑ Trailer Court ❑ Mo+e! Other ❑ Number of living units; Number of bedrooms...'jXumber of baths...1-. Lot size Water Supply: Public system ❑ Community system ❑ Private(X Depth to Water Table .. ft. Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe Hardpan❑ Previous Application Made: Yes❑ No j< New Construction: Yes❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet) Zsois.'l tica t Distance fron»nearest well.,............ Distance from foundatioA_.................MoterioL.................. ......... t No.of compart�ts:...........f.........�Size................................Liquid depth...........................Capacity_................... � Field: No. from nearest well-./40e..Distance from foundation.....f?�__.Distance to nearest lot line J_. .. Number or' lines. `....�rl..... �.._.J...'..L_ength of each line... .iQ ".. ..Width of trench..... - -..... Type of filter moierial.J. ,,� epth of filter maierial...�.. ......Total length....... Seepage Pit: Distance to nearest well......._.......-._.Distance from foundation._.......__.....Distance to neaest lot line.......... 13 Number of.pits......................Lining material.....................Size: Diameter........,...........,..Dep ..........�.Q.. . r Cesspool: Dis+Bnce•fro dearest well........__....Distance from foundation....................Lining material....-_ . .. 7 Size: Diamete �........r_...._.....,,......._Depth.._._.. ... Li uid Ca ci - - _ s,�.,.._�v-_��.:�;:�•�' �;o:a��,- Ra tY--•._...... ..........__.eels.. . . Privy: Distance from nearest well......................_.................._..Distance from nearest building..........................._..... _,._ ❑ Distance to nearest lot line �....r_�..___�./.. ................... `....,._.. _ Remodeling and/or repairing {describe):_..,__..' c�r- .. • __.�. .�.� _.�__...�.., __ ........_.................... __ _ ......_..__.._ _.��._.... ---........-_......_._.-......._..._.._..._. ................---............................._._ _._ _._.._........__.......__...__._.........._...._...._........_..........._._...............................---...._.. I hereb. certify that l have.prepared this application and that the work will be done in accordance with San Joaquin County Cos. law' s, and rues and reg Eafions of the San Joaquin Loud Health District. {Signed ..,.... _._.._ _.:._'.......,. rrer and/or �+ / l �L........._..._.....:........._._.,_.........._.......^_:...,._.(Ow nd/o Contractor) $y�._ _. . ......_f.�c..,.(:�1. -K.4e-.:!4 ..--..............ITifle)........................ .............._....................... (Plo+plan.,showing the of W.location of system in relation to wells,buildings,eta., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......................_............... ..................._.._..................... DATE_...... . -..._..... .._.......__........... REVIEWEDBY......_........_.__._.....__............................._...._ _.:..... ...........................DATE_...... BUILDING PERMIT ISSUED._...._......_..__.....__.... .., .... DATE-.............__.__.._.....__..._...__....... Alterations and/or recommendations:........... ......... ........... - ;;- e /............._._........_._.._._......._.....................,._.._..._.._. ......................................................._._._.......... ..__... ............................................._._..._....__.........._........................................ FINAL INSPECTION BY:.........:...... ..._ _: .C��'�!!t Date............... rl'...J. ............ SAN JOAQUIN LOCAL HEALTH DISTRICT :30 South American Sind 300 Waet Oak Strad f32 Syce nae Stn*+ e14 North"C"Strait Stockton. ulfornia Lodi.Califwrad manteea,Cawomis Tracy, Califon+is YL"-'%••-1M 1�6NG AIWGOD 1[•M