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APPLICATION FOR SANITATION PERMIT Permit No. t (Complete in Duplicate) Date Issued 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. JOB ADDRESS AND LOCATION_.__4? ----------------------------------- /I<-_--.�>~_ �,e .. "� -e ORa�f•__ T �Q of 1 Q 16v.K-dt! - Owner's Name------- ga_—e--------e- - � F------------••---- --------------------------- ----------------- --------- --------------- Phone.---•----Address----------------- ---•---- �qp.r.�./t1------�-`-��/=-►�Z-�4./1�.�-a----- ------ ---------- --------- -----------Contractor's Name-------•-•- -----------------•---------•-----------------•----------------------- --------•------- ----------------------------- _-- ______-------- Phone will serve: : Residence Apartment House ❑ r Commercial ❑ Trailer Court ❑ Motel Number of livingunits: - ❑ Other ❑ ._._}Number of bedrooms . ... Number of baths ._ ._ Lot size _Q"g------ J � Water Supply: Publics stem / _=_= y ❑ Community system ( Private ❑ Depth-to Water Table 46.o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&L Hardpan ❑._ Previous Application Made: Yes ❑ No SZ— New Construction: Yes 0—No ❑ `-w TYPE°OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well,;.#I-------Distance from foundation..._;/Q r fel- No. of compartmenfs-----A----------------Size.%,j.'�q--y. "-__-"-"-Material-..Cn"� ' ---- Liq Liquid de depth p c457. ----------Capacity-------0��---- Disposal Field: Distance from nearest well=14V-.__Distance from foundation---Z9.1.-- Distance to nearest lot line.----- �- Number of lines----------�- Length of each line..----- r- . F Type of filter material- ' g ,��----- K""Width of trench-------.c . .�---"--.�-i- Depth of filter material."_.. y ..". _ .Total len X�-- ! g length •--------•----- En Seepage Pit: Distance tonearest well. --,.___Distance from foundation..-- X __'__.Distance to nearest lot line...",ls Number of pifis.._ ___.._--."._.Lining material C,or 1�t�Diameter.__-� .De th Cesspool: Distance from nearest well-----------------Distance from foundation.-...- "-----.__-",Lining materiae".__.. " ❑ Size: Diameter----- ------------ -------------------Depth-------------- ---- . ------.Liquid Capacity---------------------------gals. Privy: Distance from nearer! well__._..."._ --------------------__- --Distance from nearest building 9 -_I' '`i ❑ Distance to nearest lot line-"--__-" -._- Remodeling and/or repairing (describe)--- ------------------------------------------------------- ------------------------------------------------------------------ -------------------------------------------------------------------------------------•-•------------------------------------- •------------- .` --------------- ---------- ---------------------•----••------------------------------------------------- I hereby certify-fhat I have prepared this application and that the work will be done in accordance with Sart Joaquin Coun}y ~, ordinances, State and rules and regulations of the San Joaquin Local Health District. (Signed By.--- - --- - - -- -- - ---'-�`"�-f - -(Title].... ran r Contract _. e /o ) - - -�'-------- ----- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------ ----- ---------- DATE. REVIEWED BY ------ / - ATE BUILDING PERMIT ISSUED - DATE - tf Alterations and/or recommendations---------------- - ----- ---- -.- --= - _ •• -- j ------------------- ---------------------- ----------------------- - -- - - " -t'._ -- ------ -----------------•- -- ------- - FINAL INSPECTION ------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California E5--9 145446 ATWCaa _