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1p\�� APPLICATION' FOR SANITATION PERMIT Permit No, ... _ .5�..G...: VY (Complete 1n Duplicate) Date Issued _____ Applica}ion is hereby made to the San Joaquin Local Health District for a permit fgoflnstruct and in the work herein described. This application is made in compliance with Count y Ordin ce 549. JOB ADDRESS C TIO ---- i y`'-'" f - Owner's'Name_ LQ s-Q 1"� ----- ph J Address------------------- ----- ------------------ � .-----.-.._.. Contractors Name__-_-_.___:_ ------ --------- Phon �--k�� Installation will serve: Residence Apartment House ❑ ommercial ❑ Trailer Court ❑ Mot P Other D 1 Number of living units:- Number of bedrooms __ umber of baths Lot size ____, --.-l�----------------- --- Water Supply: Public system ❑" Community system ❑ Private ❑ Depth to Water Table ---Off. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe and t Previous Application Made: Yes ❑ No �ew Construction: Yes ❑ No ❑ �C �'' •� TY STALLATION AND SPECIFICATIONS: Sep •c tank or 6peo1 permit+ed if public sewer is available within 200 feet.) eptic Distance from nearest well_________________Distance from foundation___________-_._---Material_______. ______--._____________________._.-_____. a lo.1of compartments-- - ---------------------Size--------------------------------Liquid depth----------- ---- ---------Capacity----------------------- II � - al Fiel . '�isfance from nearest well......----------Distance from foundation--------------------Distance to nearest lot line___________..._.. tuber of lines__r__....__........________•--Lengfh of each line-----------------------:-----.Width of trench-_--------------------------------- O ype of filter material......... ...............Depth of flyer material_._.____...__.!--------Total length_:___________________-_-___.-___________ Seepage it: Distance to neare wel d ------D'sstan r m fo n ation___.`taJ-_- Distan e to nearest lot line---A Number of pits--.}f-._____._._.___Lining material.__ _._Size: Diameter-_-{� _.___-Depth_:a2�________.______._ Cesspool: Distance from nearest well-----------------Distance from ndation_____..__-.___.._. Lining material-------------------------------------- ❑ Size: Diameter.-" - -----.Depth---------------------------------- ------Liquid Capacity__-:----------------------gals. Privy: Distance from nearest well--------------------- --------------------- __Distance from nearest building------------ --------------------------- ❑ Distance to nearest lot line---------------------------- --- --------------••---------------------------------------------------------------- -------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------------------••-----------•--------- ---------------- ----•-------- I, .. ------•-------------------•----------- - hereby certify that 1 h e prepar d this and +ha+ a work will be do a in accordance with San Joaquin County ordinances, tate laws, and r es an r uia+i o he San Joac{u n ocal Health Dis ict. Si ned -_._ ---- - Contractor [ g } +j+ 1 By Title)_ _[._L�-�=-'------------ - -- ------•---------------------- -------•---- - (Plot plan, showing size of-lot, location of sy e a io to well buildings, etc a be placed on everse side). FOR DE ART NT USE ONLY APPLICATION ACCEPTED BY = -------- DATE`��------.----------------------------------------------- REVIEWED BY----------------------------- -..---�------ - ---------- ---------- ------------------------------------- DATE-- ------ BUILDINGPERMIT ISSUED-------------�--------------------- ------------------------------------ --------_-- ----- DATE..--- -------------------I-------•------------------- Alterationsand/or recommendation :----------------- --------------- -- -------------------------`------------`----------------------•--------...---------•-------------•----•---•------------- ---- --- t ------------------------------------------------------------------------------------------------ --------------------------------------- ------- FINAL INSPECTION BY:."' -S------------ •----- Date-_ ...1-rd-----~- -- � SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California y Lodi, California Manteca, California Tracy, California ES-9--2M [45446 Arwood 12-54