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(��,�`� ? �• Permit No. 7....._.. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ---i7A. -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install work herein described. This application is made in comp4ia ce wifL-q ounty"Ordinance No. 549: l - ------------------------ JOB ADDRESS AND LOCATION--------- �—' ------------- �c --- ----- -- ------ ------- - - Phone----- ---------------------------- r I ��' ' ! ---------------------------------- fi" Owners Name______________f--------- - _ Al "``-rt-�°�---------------------------------------------------- -----•---- _�--�-•a-�------- _tr � :i Address---------- ---- Phone ' --PP4 �_�-- --------------- Contractor's Name----------- --------- '•------ M l . A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installs#ion will serve: Residence � p ---------- i Number of living units: _-- ._ Nu#bar'of bedrooms ___-__-: Number Depth to Water Table � ft- Water Supply:' Public system ommuni#y system El Private ❑ p Loam Clay Adobe f Hardpan El Character of soil to a depth of 3 fee+: Sand F1 Gravei El Sandy Loam ❑ Clay L ❑ y ❑ .� � HA/VA /. Previous Application Made: Yes ❑� No New Construction: Yes ❑ IVo F : Yes ❑ No El ` TYPE OF INSTALLATION AND SPECIFICATIONS: [ [No septic tank or cesspool ermitted if ublic sewDelr as available within 200 fde ] w P P -p Septic Tank: Distance from nearest well--e-------------<t ste�f� o ndatian--- --------- --- a L urd de th f C 11 apacify-----Z ------- No!. `-`' i ❑� No. of com*t66ts---------;�---- --- Size _ ------------ G R - --. Disposal Field: Distance from nearest well_ ton Distance from foundafion -- Y Distance #o nearest lot ne_______�___..__ rn f i----.Width of +rench ------� --------------- Number -- ----- tEf� Number of lines_______ _ ___ _ Length of each line____ ___ __ - ' .� Ifx � Depth of filter material----- otll length_ ,0�-�' ---------I Type of filter material_-___ 1 „1. 3 Seepage Pit: Distance to nearest well- --_.'-______Distance from foundation----!_______.___.Distance to nearest lot ine----------------- Seepage ---__ ------. p Linin material___ Size: Diameter_ I------.-- - �1 ❑ Number of pit-s-1----------------- g I Lining material Cesspool: Distance from nearest well ------foundation-_-.; Liquid,Capac'ssty___________________________gals. ❑ De th --------------3 Size: Diameter----------------------------------- p F [ k Distance Froin nearest well------------------ ..................... - ---- -- ----- ---i---cam Dista.ncefrom nearest building------------------------ Privy-. i ------------------------ Distance --- ------- ❑ ----=-------------------------------------- Distance to nearest.lot�fine__-�=�-:e----�-------------- - {� . ---------------------- Remodeling and/or repairing (describe :__- ------- --- ) ----------------------------- ------------------------------ - 1 l -------- ---- ---=-------- 3 . Yt i et i , ;"----------------------------------------•-----. ----------------------------------------------------- --------------- - 1 hereby certify that 1 have prepared this application and that the work will;be done.in accordance with San Joaquin Count ordinances, State-laws, and rules,arid regulations of the San Joaquin Local Health District: _ _.-- __(Owner and/or Contractor) (Sic ned ) .�__Title 1 [Plot plan, showing sae of to+, location of system in relatid to wells, buitdings-, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-`----CY,,------------------------------------- -= -- - -- ----- - - - - - REVIEWED BY_- `.�".�" ,---'__...�`' - - ''�'_"-_- � ___pATE= - ---- --- --- BUILDING PERMIT ISSUED-------=------------------------- - - - ---------------- ------ DATE ------- Altera#ions and/or recommd ations:- u1�a --fir . ' 3 ----------------- --•-------- -------------------------- FINAL INSPECTION BY:_-.__ -- .. _ - Date----------------- --- ---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Trac California Stockton, California 1 Lodi, California Manteca, California Y. ES-4-2M Rovisea 1.57 F.P,C0.