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APPLICATION FOR SANITATION PERMIT Permit No. .0Z.1.4-1 ' (Complete in Duplicate) w.----- .- Date Issue Applica{ion is hereby made to the San Joaquin Local Health District for a permit to cons#ruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.:.__ AY_,#Q, -,L, ,°, _ - - Owner's Name----------- ------------- ----------- A amort..-- ---- = � ------- - Phone {� � � - trr --- A - ri -- - ---- - --- - ------------------------------------- Contractor's Name---__=--•-------• - ( - --•--- Phone_ --- �/�Q•"f' Installation will serve: 'Resi Ge.. Apartment House Commercial +. p ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _t_'Number of bedrooms _ Number of baths J__-_ Lot size ____��,a '--- -_ -, "_+" Water Supply: Public's stem t pPY� y ❑-" Community system ❑ Private Depth to Water Table�Q_ ft. Character of soil to a depth of 3 feet: Sand [I Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay E] Adobe Hardpan ❑ •V�� Previous Application Made: Yes ❑; No>C �New Construction: Yes ❑ No ❑ TYPE `OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E Septic Tank: Distance from nearest weNf _!..-_.Distance from foundation-4.0— No. of compartments____ Disposal Field: Distance w �- ,. y aCYb a yepp . — , p : from nearest w 1�l�-- Distance.frroom ounaation�ll-__-;__._.Distance to nearest lot line___�A2--"!. :N m'ber-of lines___-�_______________ ___ _______Length of each line0,e _- --i--__.Width of trench____ __ --a__ C Type of filter material_l'� ___Depth of filter material_ s� -___.Total leng �O Seepage Pit: Distance fo near'est 1--10+C�') --t Distance" ro fo ndation___�040.'`___.Distance to nearest lot line: Numbar of pits:.:___._-_.__-______ ming material_: -_ _ Size:,biamete`r___ rs u A'si --- ----- Depth_:_._ +�'r t Cesspool: ' - p Disterice from.nearesi well----____,---_.__Distance from foundation_-.__.`F-____t_-__.Linin material_____________________ El Diameter- _. i ------------------- -----t Depth-------- ------ ------- ----` ---- -=---:Liquid Capacity -------------------- gals. a Privy:' Distance from n4earest well _._ _.4._ ' - ` I ` ---c --- ----- ;-_P--Distance from nearest building------------•------------•-- s -stance to nearest lot line_:.---------------------------------------------------_ """'� _ = -�_ - J -----------------------------= I Remodelin and/or repairing (describe).--, ' --------------- g / p g (. ) w . a . I I ordinances, Sta i f and les-a .regulations li afi San-- that ___________________l _._ hereby ce of that I h ve pr red this applica+ion and that the..work will be done :in accordance with San Joaquin County Joao in.,LocaINHealth District'. {Si ned - g . )----------- r- ------------ -- F - ontractor) or C - -- - = (Title)- a�1 Q-.......------ (Piot plan, showing size of lot; location of system i ation to wells buil '�igs, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATt REVIEWEDION BY_ ACCEPTED BY - _2= _ --- - ------------------ DATE---------------G,!� ---�-- --- --------"--------------- DATE_._._ (__----• . - -----------•- ---- BUILDiNG PERMIT ISSUED -° = --•---------------- DATE. �. ----------------------- Alterations and or.recommendations:_-__ y t --- ------------------r___ �rQ` ``a ---------- �- �.1[.c. —---- _: ----- Q..9J r .�_��___________________________-- •------ ----- ---•------- ------- ------------------------- FINAL ------ ---- 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 ES--9-2M Revised W-2100