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APPLICATION FOR SANITATION PERMIT Permit No. .� (Complete in Duplicate) 3 _ Date Issued --r•3-1-•:&_1_- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. T Thisµapplicat on is made in compliance with County Ordinance No. 549. 21,? r�Q(057,mj ,4 -c-A4 W JOB ADDRESS AND C,�,TION_. o ----------- - Owner's Name--rt------ -------- - D O V,----- = - -.- -- ----- ------ -- --•-------•"----- Address . . le�. --11 /OO Q ------------- Contractor's Name________ ___ ____ ------•------------------------- --- --------------- - ------ Phone------------------- ------ -------- 0 will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer&0?jrrjCzej1_4&t_e Motel'❑ pth Number of living units. "'� Number of bedrooms-""-_ Number of baths. __ --------------•--------------•----- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table _3ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ 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_ 'O__---"Distan e,from foundation_-= _d_=__ -. at nal:___-__�_ -,_�_ No. of compartments------ -- - off__"_--. --Size-- ". -- -- -• Liquid depth-------- -i-3„�-----------Ca acit __ --0 Disposal Field: Distance from nearest well--- Distance from foundation-----L.7!7:....Distance to nearest lot line_ ( Number of lines---------1--------------------- Length of each line---------- Q--Q---.,Width of trench-----,X---•-------- .. Type of filter material_ ' Yp ..��-- __-- ---_Depth of filter material--------�-�.""---Total length-------------(p d_._____"________"-- {Q Seepage Pit: Distance to nearest well----------------------Distance from foundation_______-_--_-_____.Distance to nearest lot line__----_.______ ❑ Number of pits.___-----____-.------Lining material________________ -----.Size: Diameter-------•---------------Depth-------------------------------- Cesspool: Distance from nearest well____ _Distance from foundation.__--.----.__--__-.Lining material______-__-.__--_-_.__-_______.------ ----------_----------❑ Size; Diameter. Death------------------------- ------ n __; : Liquid Capacity---- - _--w gal rivy: Distance from nearest well-------.-------_____-----------------------------Distance from nearest buildin 9 ❑ Distance to nearest lotline_________________________-__.___ " - ----------------------------------------------------- Remodeling and/or repairing (descr;be) --------------••------ -----•---•----•-----------------•----•----------------•-------•---------•- ------------------------------------------------------------ -----------------------••-------------------- ------------•--------------••--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of t e Sa Joaquin.Local Health District. (Signed)------- "�� `�' CZ e r �( -"-- - ._-"-`4- 1--...__(Owner and/or Contractor) By:. - _ ------- --ITitie} ------------------•---------------- -------•---- ----- (Plot pian, showing size of lot, location of system in r� tion to we uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED_ BY--------------------- ------------------ -- -- ------ -- ------ DATE------ - REVIEWED BY-------------------------------- ----------- -- ------------------ DATE BUILDING-PERMIT ISSUED ----------------------- ----------------------------•----- DATE---------- - ---- -- ---------•------ Alterations and/or recommendations_______________ --------------------•------------------------ 17 T FINAL INSPECTION BY:--------- Date----- -- � .. SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi„California Manteca, California Tracy, California X5'--9 145446 ATWOnD