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^j APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with,County Ordinance No. 549. JOB ADDRESS AND LOCATION...---:3 .Q- -G• -�. --------- "�' .�� one � Owner's Name------- -P.IV_-•h:-------/_3 -------------------------------- - - ® . k Address----------- .r~ la. ��t�?„�_`..---------------------------------------------------------------------------------------------- Contractor's Name---- --------••-•------------- ------ Phone-------------------------------... Installation will serve: Residence Apartment House ❑ Commercial,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1- Number'of bedrooms .��-.--• Number of baths -1 �� ----- Lot size _ �?.----�-----•1-�-�-----•--•------•------•- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 'New Construction: Yes ❑ Nov<' TYPE OF INSTALLATION;AND.,SPECIFICATIONS: ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) t gkktQ Distance from nearest well-----------------Distance from foundation__-_ --..M ------.---- aterial__-- _ ---------------------------_---- .--_-.----. ❑ J No. of,compartments---------- - ------------Size----------------------•-------Liquid.depth-------------------------=Capacity--------------------- ii LV Disposal Field: Distanco from nearest well J1 v2J_tr`Distance from foundation-/-Q----------.Distance to nearest lot line_-�--- Number of lines---------/----------------_-__-Length of each line------j--fid--ii------Width of trench-.o�+�y __-1�-- _._..-.-.---_-- Type of filter materiai_6.-C .I�,--` Cif filter material-� 5L- --__-_Total length-_ �------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--__,.-_----___--__.Distance to nearest lot line-----.----------- [] Number of pits----------------------Lining material-------------------- _ Size: Diameter------------------ ----Depth------------------------- Cesspool: Distance from nearest well ell----------------Dst+h Distance from foundation.------- Lining material - ---- ---- -- ❑ : Size_ Diameter-----. - i -------------Liq -._.---- - -- ---_-- alO Q Privy: oj Distance from nearest well .............._-.----.-------------------_----Distance from nearest building--------------------------__----.---.---. ❑ Distance to nearest lot line--------- --------- ---------------------------•------ ----------------- --- -------------------------------------------------•------- Remodeling and/or repairing (describe):-_ dC�/.�7 ------72-. ' --------------••--•--------•---•----------------------------------------------------------------•------------------------------------------------------------------- - ! ----•-----------------------------------------•------------------------------------------------•-•--------------•--------------------------------------------------------------------•-----•-------------------------------- t I hereby certify tha+ I have prepared this'applicatiori and'that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---------- Owner and/or Contractor) i (Signed)--••------------------------ --f. , ( / ) BY:-------- --------f -�..--------------------------------•----------------(Title)---------------------------------------------- --------- ------ (Plot plan, showing size of,lo+, locof sys+em in relation +o wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-.------ ...--- ---- - -- --- ----------- ------- --------------------------------------- HATE----- %2----------- --------------------------------- REVIEWEDBY I ------------------------------ -------- DATE --•-----•---------------------- BUILDINGPERMIT ISSUED----------------------- ------ ----- --------------------------------------- ---------------.._ DATE..----------- --- -------- ----------------------- Alterations -- -- --------------- Alterations and/or recommendations---- ------------- --- �------- -------------------------------------------------•-••---------••---•--•---- -------------------------------- ---------•--------•------------------------------------•-------- -•-------•---•----------•--------------.----------------------.-------------•------••------------------------------------... ------------------------------------------- '-------------------------•-------------------------- ------------------------------ ----------------------------------------------------••--.--------------------•-------•------- FINAL INSPECTION Date---- ------ --�---------�- - `----------------------- 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 E5-9-2M 145446 ATWODP 12-s4