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APPLICATION FOR SANITATION PERMIT Permit No. 6 1 ._ �--Ll to (Complete in Duplicate) J .. y Date Issued / Application is hereby made to the San Joaquin Local Health District for a permit to construct annyiZfiall the worh�erein described. This application is made in compliance with County Ordinance No. 549. �dUrQB K/. W �r JOB ADDRESS AN tL' CA-CA -A ------ -- / z� Owner's Name-- --- -- -------------------- - -- _------ -P--hh--o---n-e--- •--- --------------•--------------- 4`�� - ------ -- ----- --------------------- ---- - one------ ---------------•-------- Address.------ -------• �. –y ---------------------------- - ------•-----. -----------•-•--------•----------------- Contractor's Name----------------------------- Installation will serve: Residence-y "Apart nt House ❑ Commercial ❑ Trailer Court Ej Motel ❑ Other ❑ Number of living units: Number of bedrooms -_--;--Number of baths .--- --_ Lot size _!! Water Supply: Public system' Community system 0 Private efh to Wafer Table itD . J � PP Y� yp Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ P Previous Application Made: Yes E] No New Construction: Yes V No ❑ � ±� TYPE OF INSTALLATION AND SPECIFICATIONS: °Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se)t'Tank: Distance from nearest well_ --Distan fro foundation- -- ) Mat I ` t---- No. of compartments...-_-.._-_�r+''_-__-_-Size__ _�_�� Liquid depth________ _ �3 8 r - "° Capacity---8-, 0--- Disposal Field: N. Distance from nearest well__ 31P1>-Distance from foundation--- __- Distance to nearest lot line______•, Number ai lines--------_ -- - --' Length of each line- -- .,�s-.WVtl h of tr nch_________________________ Type of filter material_-----', "' -$ape th of filter materi p , 'r '-ft, 7nerest ---------/-"0;?- ------ Seepage Pit: Distance tonearest --- ----_-._--_Distance from foundation_-----..____.___---.Dsnce to lot line_.-___-.-______-_ ❑ Number of pits----------------------Lining material- Diameter-------------- ---------Depth----- ------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----.-_-.---_.___Lining material--__-- ❑ Size; Diameter ---.. ----- Depth----------------------------------- Li uid Ca acit - � � �� -....... w._w .-:�- ,ter ..�.--=_ .� em . ��:=:---:,..,g_�.�,�,� p�_Y_-�--�� ---------gals, Privy: Distance from nearest well------------------------------------------------- ------------------- ---- --__----_Distance from nearest buiidin g Distance to nearest lot line------ Remodeling and/or repair•ng (describe):_.._-_ V ---------------------------------- --- --------------- 1 ,. � -- ---- �- -----------.--------------------------------------------•-.----- ---------------hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations 6f the San Joaquin Local Health District. (Signed).g ) ------------- -----------(Owner and/or Contractor) ----- By:.----------•„ -----------------•------------------------------------------------------------ Tale ____ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYREVIEWDATE Y' ---------------- r ! DATE_ 1 ` ED BY- -- --- E - ---------•-------- BUaLDING PERMIT ISSUED_____________________________•_�- f.� 1.f' ` ' -------- DATE------ _ Alterations and/or recommendations:---.--------__---- - ---- --- --- -- ----•----- -------------•------- ----------•------------------••------ - -----------------------_ _ ?------------ FINAL INSPECTION BY:-.----- ------ ------ ----------------------------- Date-- ---------------------- - �` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California E5-9-2M r0-52 Revised W-2100 f