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APPLICATION FOR SANITATION PERMIT Permit No. U (Complete in Duplicate) _ v Date Issued ----------•--.--•-•.--- (Ir1q. Mrt E' ov OSI --fno_pZ Applica+ion 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 LOCATION--.._ .?'C iL�` - , !? 7 A'a{Y6-----A'�..- l J -----G- y - _ 'P D V�� -------- Owner's •--- Owner's Name.._ ---- ----------------------- ------------- Phone----------------------------------- Address--- ._ ..: 1'l---------- A -'r----- ---------- Contractor's Name-..- J9'.R_ '-`S l'� 'fif --•------------------------•--- Phone...... :-------- j a G Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oer ,�� Number of living units: __..-.-. Number of bedrooms -------- Number of baths -------- Lot size _._, tP<=........................... Water Supply: Public system ❑ Community system 0 Private ❑ Depth to Water Table ,-?. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Preyious.Applica{ion.-Made:_ Yes;❑ _No ® New Construction:-Yes. _ o_.0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Z Septic>fik: Distance from nearest well- .�.Distance_ from foundation-_r�._'t�v� Material.-Gr__�._.� ! IT No. of compartments----- ---Liquid depth------ ' Disposalield: Distance from nearest well:,-[��_r_Distance from foundation.---`J..____.Distance to nearest lot line---- Number of lines------------ Length of each line-----------. ___df Width of trench-------A-V................... Type of filter material-----I-......:..'._Depth of filter material_._..I_e_`r____._Total length--------- 2U--------------------- o Seepage .it: Distance to nearest well.,X4!_6--------Distance from foundation---- .4j.....Di tante to nearest lot Number of pits........ __- Lining material_ 1_��•X�• Size: Diameter___.x.... �.�_�.,.Depth_d+ Cesspool: Distance from nearest well................Distance from foundation--------------------Lining material-----.._--__-------------__..__.___.- ❑ Size: diameter------------- =--- -----.Depth------ ------- ---------- --------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--- ------ --------------------------------------Distance from nearest building------__-,_----_-_._----------------____-- [] Distance'to nearest lot'line'-------------------- ---------------- --------------------------------------- --•----------•---------------------------------------- ` Remodelin and or re airin describe r f� -------------- ------------------------- ()� . __ .. �._f':__�. ........... .....+ ......_..._J -._.J..�...._lY.vd�'�'9i ......L�./�f_._c�t9_rJ� `L r -------- ------ ----------�'�_. A x------------•- •------------------•---•--•------------------------•--------•----------------------------------•-•----------------------------- •--------------------------------•----•-•---•--------------------------------.------------------------------- ----------------------------- --- --- -•-------------------------------------------•-----------------------------------•------•-----------------------•-----------------------••---------- -----------•---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staflaws, and rules and regulations of the San Joaquin Local Health District. --[Signed}_' - ' y------ ` ' � - = _ caner and/or Contractor} - �w 4 7- - y: ` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-4Z - ------------------------- ----------------------------------------------------------- DATE�---------------------------------------------------- REVIEWED REVIEWED BY ----------------- DATE r�-------------•--•-------------------------------- BUILDING PERMIT ISSUED-------------- ---------------------------------------------;---------------------- ---------- ------ DATE..-----�------------------- - --------------------------- Alterationsand/or recommendations:--- ------------------------------------------ -----------------------------------------------------•-------------------....------ ------------ ---•-------- -----------------------------•-------• ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ---- ------- ----------------------------------------------------------- ------------------ -------------------------------------------------------- -------------------------------- ------_ -------------------------------------- ------------------------------------ ------------------ ------ d FINAL INSPECTION BY:_ . . Date---- -..r 'aJ ------- ------------------------------------- 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 146445 ATwooa lz-54