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�! APPLICATION FOR SANITATION PERMIT Permit No. .......... ........... "'! I (Complete in Duplicate) Date Issued __ __3 `S Applica'ion is hereby made to.the San tJoaquin Loeal Health District for a permit to construct and install the work herein described. This applicationis made in compliance with County Ordinance No. 549. n t -------------------------- JOB ADDRESS AW LOCATION /• r--- , L 'r A-I�t--• Q ` - F --- •-- N Phone Owner's Name_ - ---L l ! �'..6A----y--/- :_ - • - -------------------------------•--- ---------- Address----------- ----= h A.. Contractor's Name. 11• _ s �i-... ;---------" ---- P one '- Installation L will serve: iResidence ❑ Apartment House ❑ Commercial X Trailer Court (] Motel ❑ Other # ---- Lot-size __1Oa�C_:I_,� ----•------------------------ r Number of living units: _ -____ Number . . bedrooms __I___. Number of baths �- Water Supply: Public''system ❑ Community system ❑ Private'N Depth to Water Table _ ft: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [IClay ❑ Adobe Hardpan ❑ Character of soil to a depth of-3 feet: f . t Previous Application Made: Yes ❑ No �+ New Construction: Yes ❑ No 1 TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tankorcesspool permitted.if public sewer is available within 200 feet.). #� *ro a ,.�..�.rm v _.�. x,. -- i Septic Tank: Distance from nearest wall________________IDistance from foundation___.____.-_____..__.Material------------------------------------------------- id _-_____--_____--_----------------- ----- W Size Li uid de th--------------------------Capacity-------------- N ❑ a�+s'"�& Nod of compartments--------__-=-----•--_- 1 q Disposal Field: Distance from nearest _____Distance from foundation___-__________.....Distance to nearest lot Gne__________-..____ ❑'FX 1Sf�r�G Number of lines -= iLength of each line------------------------------Width of trench------------------------------------ El ----------------------- ------ 3 Type of filter rinatenal-- ----------4 Depth of filter material---------------- -----Total length--_----------_----------------------.•---- D ' r .€ • Seepage Pit: Distance to 71,2-0 is 4Distance from foundation____-__..__.Dist�arnce to nearest lot line __-____.GS Number of pits__ Linin material_$ --1'�=---Size: Diameter____ _ __��-------.Depth___ IC o Cesspool: Di tense from nearest.well_______________'Distance from foundation--__--_____.__._--.Lining material__-______--____--------------------- s1 ❑ Size: Diameter-------------------------------------- ------- ------= -------------- ---=De th---------.------------------- Liquid Capacity_ gals. Privy: Distance from 'nearest weil_-------------{ --- -----------------Distance from nearest buildin�j-_------------------'--------- ❑ - ..'� -_ --�^ ._-'�- -- ... ______._-_-------_---------•-•-----•--------------------------------------------------- F1 --------- T —Distance to nearest 'lot line------ --£ -- --------------- 77., ----- ct T"i.p_n� `" Q E Tr ----. RATA—ACE------ Remodeling and/or repairing (desciii�e.�:=.__ ----- ----- - s - #, ---------------- -----------------------------------------------------------------•--------•------ 1 _________ ___ _ _____ _ __..-___h_--_-._____-___...________-________________.___________________________..____-___________-_--____--___..________. __________.___________._--.-_______ I.hereby certify that l have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, State rules and regulations of the San Joaquin Local Health District. . i r r - r and/or/�-- _ _�.r�_ `" 0 ----------- ------ -- - {Owns d/o Contractor (Signed) -- ---------------- By:---------------------- -- - -- -•--`�--'-- --------- - --=----=------(Tale)------- --- - --- --�------------------ (Plot plan, showing size of,lot, location of system in relation t wells, buildings, etc., can be.plac on reverse side). FOR DEPARTMENT USE ONLY l F W. _J -f DATE 73 (5 -•---------•------------- APPLICATION:ACCEPTED BY_____________ _ REVIEWED BY------- ------------------------------------: :-------- ----------------:`------------------ DATE _ ; BUILDINGPERMIT ISSUED--- y = i--------------------------------------------------•----------- Alter - ----------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------.---------------- -•-----------------........-------------------------•------------••----------------------------- ---------------- ------------f---------------------------=------------------------------- -------- ----------------------- . ----------------------------------------- --------------- ---------------- - 1 i ----- --------------------- r - ----=-�--•.--- Date. -"'_-' - � -----------------------_. --------- O � "---- FINAL INSPECTION BY::__:_T--` SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street t 30o West Oak Street 132 Sycamore Stree+ 814 North "C" Street Y Stockton, California Lodi, California- Manteca, California Tracy. California ES-9-2M Revised W-2100