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APPLICATION FOR SANITATION PERMIT Permit No. /_._�__? (Complete in Duplicate) y } Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This application,is made in compliance with County Ordinance No. 549. JOB ADDRESS AYD/L/OCATIOtN�----/O1Y� 1 -1-- C��/ ---------�-t ------- } _ ' T�//)/�C------- Q 1 _ ------------------------------------- Owner's -------- _1T 1,r%------- '} -Id--�----------------------- ----- Phone------------------------------------ Address--*----6,n.�'R�� ,6.....-1 ------------------- Contractor's Name. + r1 L��-"' 1 F% - ` .,�of ' ------------------------ Phone---7_r- f��-------- Installation will serve: Residence ❑ Apartment House ❑, ,Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living' units:/_�'ANumber of bedrooms -- Number of baths -------- Lot size _ .._ �____________________________._ r Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table6o__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ q /�� 1 TYPE OF INSTALLATION AN6 SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer available within 200 feet.) Septic Tank: Distance from nearest wellAZ--_....Distance from foundation----t5------------ Material------ ---- -------------------- No.'of compartments__-- -- 5ize �_=S _S�_S -. :Ic;uid depth----- Q"----------Ca pacityr2«5_Q�__ �`' � Disposal Field: Distance from nearest well_ Q _. .Distance from foundation-slil _Distance to nearest lot line-- +�. �.-.__ p » � Number of lines____-_- Length of each line-: f_____ f`---_Width of trench--l-24--If ti Type` of filter material/, ___��-f�'�-Depth of filter material-_/ d1---_.___Total length-_____z1 �_� ________ _____t ' 7 Seepage Pit: Distance to nearest well ------Distance from foundation_ _ _�___________Distance to nearest lot lin - I Number of pits_!�_A'�--------Lining mate rial__ J ! ---Size: Diameter- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material___----------------.___.-.--.--.____ ❑ Size: Diameter--------------------------------------De rh----_--___-_------------------- --_Liquid Capacity ---gals. r Privy: Distance from nearest well.-_--------------------------____.-------------Distance from nearest building----------------------------- ---------- (1,� ❑ Distance to nearest lot line------------------------------------------------------------ --------------------------------------------------------------------------------- "! 44 Remodeling and/or repairing (describe)."Z7 �1____ ----,�4�--------- -- 7Counfy--------------------- ------------'---•-------! ' ,/ ,+ ��. � - ' ' - --------------------- -------------- ------------------------------------------------------------------------hereby certify that I have prepared this application afnd that the work will be done in accordance with San Joaquin ordinances, State laws, and rules ag-c! regulations of the San Joaquin Local Health District. • y {Signed)-----�--A -_e------ K_A4_ , � . � ------ - _A-d lf�------ � ----(O.wnel and/or Contractor) By:. �i - l:f�J ' - ---- --- . .c-43 ------------------------ (Title) (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). I' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY--------------------------------- --- DATE = REVIEWEDBY-------------------------------------------------------------- ----- ---------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------ ------- DATE------------------------------------------------------------- Alt tons and/or recom dations: f= _ ��z A --- r ' J>' .—A E - -- -- -- " * ! -- - -- / r f t -- ---------------------- --------------------------------------------------- -------- - ---- --- - - �'/ I FINAL INSPECTION BY: ` --- Date 's -� ' SAN JOAQUIN LOCAL HEALTH DISTRICT SII 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+rest Stockton, California Lodi, California Manteca, California Tracy, California s ES-9-2M B-51 Revised W-2100