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APPLICATION FOR SANITATION PERMIT Permit No. ................. [Complete in Duplicate] 6 -—1 '% Date Issued __-1-�_____-_____.__`�` Applicakion 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 O ATION-�. D.-7 _ ------------ �-- - - ------------------------------- - - --� Owner's Name - Phone-----------------•-_-------------- r �r 3 Address-------------------------- � g Contractor's Name_..---------ta-�.�--- _�._�_.�-- - A-7-1------------ = •- ------------------------- Phone-----•- ----------- Installation will serve: Residence ❑ Apartment mmercial ❑ Trailer Court ❑ Motel ❑f Other ❑ 1-1 ,010 Number of living units: ---6- Number of bedrooms!A- Number of baths _- Lot size ________ _ '_'_---_--I_ 4____._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes 0o E] New Construction: Yes [-] No ❑ {i:... .. TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k:-y" Distance from nearest well------------------Distance from foundation--------------------Material----------------------------------------------__. No. of compartments------------- ------------Size--------------------------------Liquid depth------------- ------------Capacity-•------------------•-- D -osaall FpSeld.' Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line_____-__•______._ I Number of lines-----------------------------------Length of each line------------------------_-----Width of trench---------.-------------------...--- Type of filter material__-- .... ..........Dept obi t material___..___...__.__...__Total length______---___________ ____--.--___________ i See�a,�ge it: Distance to nearest well-. -� Di anc rom f u ion__ _ _.__.Di #a /� to nearest lot line---- - PuNumber of pits----------------------Lining ma erial---- ----------- ---- Siz : Diameter__. ----------Dept'n--- -., ----------.�,------ Cesspool: Distance from nearest well----------------- istance from oun ion--------------...__.Lining material-_.__._____________________.___-_--. ❑ Size: Diameter------ -------------------- ---------De -------------------------- ------------.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________________________________-____Distance from nearest building ❑ Distance to nearest lot line--------------------------------------------- ---------------_--------------------- Remodelingand/or repairing (describe):- ------ ---------------------------------------------------------•-----•------------•-- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- v ------------------------------------ ----------------------------------•-------------------------------------•---• -••--------•-------------------------------------------------------------------•---•------------------- I hereby certify that I have prepared this application and that the work will be done in accords ce with San Joaquin County ordinances, State laws, and rules and regulations of the San aaquin Local Health District. AY HT js j�. D $e I�1(� - ---1--- -- ----------------------- w - r Contractor) [Signed{----�=-�--.:�ti: .a---------------��„F!d tlE_-'��a�rf-�---------------- �� By. .+ j •xa�So. Eldorado i-1�2-T! u V- 1f;C I -- - '�' y..w.. -x----- {Tit e)-(Plot plan, showing size of lot, location of system in rel i t�rells, buildi , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ham„ •----------------------- DATE_. _-------•--------------•-----------•--------------- REVIEWEDBY----------------------------- ------------------------------- DATE-----j;;,-- ---•---------------------------••-------------- BUILDINGPERMIT ISSUED------------ ----------------------------------------------•---------------------------------------- DATE_._.__71A---------- --------------------------------------- Alterations and/or recommendaf ns:__..__.___.._.-__._...... ............_.-___ _ `' --------- ------- ---------- FINAL INSPECTIONt ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California + E5-4 145446 ATWOOO