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\Ij APPLICATION FOR SANITATION PERMIT Permit No_ ______g'�__________7 (Complete in Duplicate) ________ // Date Issuedl--� / _" 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. r..,f ..�..... .._.�� JOB ADDRESS AND LOCATIOk_ _ --- 5-,- , j---1-- Owner's Name-____ '' -- -4-1 -------- ----. - . � l le_ _ kC --- -- - �, 1�-I>- - Pone-------- ------------- Contractor's Name----- _ Address �}p --- ------------------- ---------------- ---- - •• iQ-/ ---------- -------- ----------------------------------------- Phone = Installation will serve: Residence X Apartment House E❑ Commercial _ [I Trailer Court E] Motel ❑ Other ❑ Number of living units: Number of bedrooms"-- Number of baths -_/-_- Lot size __/__ Y- Water Supply: Public system - `---------- y ❑ Community system � Private ❑ Depth to Water Table .4-0 ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe 2k Hardpan ❑ Previous Application Made: Yes fK No ❑ 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 nearest well- C?..^__'Distance from foundation__fd_f_"""-.Material____ ." + No. of compartments-------- - ,. ------" Size_", - _.�Co---Li Liquid th_ � - -- P Y- 80-0- Disposal Field: Distance from nearest weil_se D4I_`Distance from foundation______.____.---Distance to nearest lot I,ne� ____,-• l�r __.-__Length of each Gne_________'"� Q Number of lines___-.------(__-"-_-. --- -r_"__._.Width of trench_.."" lf Type of filter material._f -"-_i e.._D,pfh of filter material...-_�.g__ • t � --- ._Total length--- -----�„�--------- ----- eepage Pit: Distance to nearest well.- " .Distant rom foundation_____&0_4__.Distance to nearest lot -- Number of pits.- _-_1___-______"""Linin material_ OG �s d-� r Lining - - f---98' meter------4"-. Depth------ar4�--__________ Cesspool: Distance from nearest well_______________Distance from foundation.---------- --____-.Lin ing.materiaL_._.___._.._ ❑ Size: Diameter----------- ----------- d - - is Doth Liquid Capacity .............----- gals. IQ Privy:. . Distance from nearest well___________________________"------------------- _Distance from nearest buildin ❑ Distance to nearest lot line 9 = ------------ ----"-----------•---•----"-•-- --------------------------------------+-------- Remodeling and/or repairing (describe)----------------------__ ---"------------•----- • ----•------ ------------------------------•-------------"-------------•---------••---------------- ----------------- --------------- -----"--•---------------••--------- a I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed �/S__1..�__-h---------•--_So.Als.------ .- ------------------------•------------•---------- (Owner and/or Contractor) By:.-- `r --------------------------------------------------- {Title �onev',rss a .r�►, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can'be placside). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- REVIEWED BY - -------------- ------------------------------- ------ DATE-----IV - BUILDING PERMIT ISSUED :. = DATE �---=-i--------•-------------------------•------- - -- DATE Alterations and/or recommendations______________ - ~ ' ----------------------------•- --• --- _ -- .. '_j 1 :moo; - - ` - :-------•------••------•--------:--------------------• ---- ---------- ------- FINAL- INSPECTION BY:....-- -- a {/ Date......-- -.-.-. -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street Stockton, California 8l4 North "C" Street t Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOOO FI