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1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in in Duplicate) . - � Date Issued .___7�� - 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 JOB ADDRESS AND LOCATI.�N__.. � - Owner's Name "------ J_. �' Address ------ _-..-----Qne ----------------------------- Contractor's -------------•----Contractor's Name. - f2. �«a --`' Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms —Number of baths _- Lot size -- ----- --------------------------------- Water Supply: Public system M___6ommunity system ❑ Private ❑ Depth'to Water Table ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay-Loam ❑ Clay ❑ Adobe �Iardpan ❑ Previous Application Made: Yes ❑ No 9�' New Construction: Yes 8'No ❑ V 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_:. " Dista from foundation__/Z---____-_Mat�a�_. No. of compartments_ X _ __s _._'Liquid depth___ _Ca Capacity . Size__ Disposal Field: Distance from nearest well.&WO-s'_Distance from faundatiori;' -__:..._Distance to nearest lot line.".� _�__- Number of lines_____i Len th of each line..___. h - 9f1 -----Width of trench Type or' filter material . / _ _ -" epth,of filter material--__.0 ".....'.__.Total length....._. ----------------------------- Seepage -------------- 1� O Seepage Pit: Distance to nearest well_-"._.._ �'.-Distance from fours 'ation_�49------___.Distance to nearest lot line--Z of pits_-!.-_l"--..__.___Lining material '- `.__Size: Diameter___.- ------ ---.Depth-------�".`'-`----- -"-_ 1 Cesspool: Distance from nearest well _._ Distance from foundation.- ---------....Lining material------------_------___________ ❑ Size: Diameter------------------- -------------- Depth------------ --------- --'- {---Liquid Capacity------------------ ---------gals:..,..` r - ---------------- Privy: Distance from nearest well-----------------------------------------------_-Distance from nearest buildin ❑ Distance to nearest lot line building ----------- Remodelin nd/or repaid g (describe :_._____,_. / r -- -----•- > J - -------------------------•----"-------•--------- ----------------- -------------------••------------------•----------------------- ------------------•- - }----- --------------------------------------------------------------------------•--------------•------------------------------------------------------------ ------------------------------------------------------------------ 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 andegulations of the San Joaquin Local Health District: (Signed)-------------- a. 4 r Contractor 8y:. L�of, --••--------`- ------ ---------- � fit- -----------------(rtle) -_ _ ----------- (Plot plan, showing size of location o ystem in relation to wells, buildings, etc., can be placed on reversefoej. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------.._`----{---------- -------------- DATE--------�-.-- f-- -----------------------------•------------- REVIEWED BY-------------------------------------------------------- '",--------------- -- ---- ----- - DATE---•----- ...� BUILDING PERMIT ISSUED---------------------------------- - ---------------------------------- -- --- ------ -----------------------------•-----------------•-- DATE----------------------\ *- Alterations and/or recommendations:___..._---- =_ s - - --------------------------------- -------------------------------- �- -----------•------------------- -_.__.___.._.___.__--"-"______________ ___._ -- _ ----------- --- - - __ �,{��. tae?. l3 -___------------- ------ - -------------"------.._--_-_-____...._.______.. .-_---_-"_---._- ---------------- _______ _ ----------------------------------------.-------------------.............."-"....._------._-----------------------.--------------------------------------------------------- FINAL -... .--• ---- - -- - FINAL INSPECTION ... » , 'Date ' = = ------------ ------ ----------- -----------•--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Scree+ 132 Sycamore Street 814 North+ "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWgQp 1Z-54