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APPLICATION FOR SANITATION PERMITPermit No. '. __._. .._ ____.- j (Complete in Duplicate) S Date Issued ___ ___._s ... Applica+ion is hereby made to the San Joaquin Local Health District for a permit to c�onstruc and install t e work herein de�4cribed. This application is made in compliance with County Orrdjinance No. 549. i .ted JOB ADDRESS A LOCATION_� ••!,ll .4-+r: - = L [•#& ,,,-----e----•---¢- ---------- L' Owner's Name------- ---------• ----------------------------------- ---------------------- --------------------- Phone.4-- _Zx7ood--- Address- ---------------- a _ �"ste f Contractors Name----- P�_ _` --- .. - - - - ---------- -- -=---------------------------•-------- Phone__/---�--Q_f_��.__ Installation will serve: Residence [ partment.House ❑ Commercial ❑ .Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L Number of bedrooms _`Number of baths ___L Lot size .__��_ :1k— -------------- Water Supply: Public system ❑ Community system &Zprivate ❑ Depth to Water Table _� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No [jj�New Construction: Yes ❑g-lo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Tank: Distance from nearest well-12-00...__Distance from foundation__-- O!---_-Material__ No, of compartments_.. Size _ � � �`zC_ _��,_Liquid depth---cam--��i----------Capacity---�-`�� %C41 Disposal Field: Distance from near sf weil_./.�bfl___Distance from foundation._---1.(...___.Distance to nearest lot line__. ._, rf Number of lines__.T______._ILength of each linea_�_.__ Width of trench--s�--�/f----------------- l r�! S Type of filter material__{. - __._/_Depth of filter material___/-_ ._/f Total length--- - ------_--------------- s Seepage-Pit: Distance to nearest welL_1_1"-".'`t"_Distancem f undation_._.�.�______.Distance to nearest I Number of its_-_I---------------Linin material_ _ Size: Diameter__J9`� ' 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 kne-----------------------------•--------------=------------------- Remodeling and/or repairing (describe)-------------------------- ------------ ----------------------------------------------•--------- --------•------••-------------------------------- # ------------------------------••-•-------------------------------•---------•-••----• -------------------•--- ----------------•-••---------------- ------------------------------------------•-------------------------•----- --------------•-------------------------------------------------------------•-----------------------------------• -----------------------------------...•-----------•------------_-. ------- ------------ ----------------------- ------ r ----------------- -----------------: I her y certi hat 1 have prepared is application.arn that the work will be done in accordance with San Joaquin County ordinance , State law and rules d regu tions of the a oaquin Local He Ith District. //;;�� (Signed) ••u ---- ---- -----= ---------Afells, -- ---- - - ----- ------------------ -------Ll.[ �r Contractor) S By:-- -------•-----•------------------------------------------------ ------ / -- -----(Title)--- -4 'l� . (Piot plan, showing size of lot, location of system in relaildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- - -•---- DATE- ---- 1 REVIEWED BY ---------------- ------- -- DATEI , /IF_S___ BUILDING PERMIT ISSUED------•------------------------- --------------------------------------- ----------------- DATE---- ----------------------------------------------------------- --- --- - ------------------ ----------------------- Alterations and/or recommendations----------- ------ - - ------------------------------------------------ ---•-------------------•-----------------------•----- -------•-•-•--•-------------------------- ----------------••- ------------- ------------------------ ........---•-•-----------------------------------------------------.-------------------------- - --------------••---------•------ ------------ ----------------------------------------------------------------------•-------------- -------------- ------•-•-----•--------•--------------------------•----------- -------------------I------------------------------------------I------•----------------•------------------------------••-••--------------------•--------------------...---------------------------.----------------•---------- -----------------------------------•-- ----------------------------- - - ----------------------- ---------------------- ------ -------------------------------------------------------------------------------------- I FINAL INSPECTION BY----------------- - 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 es--9—gM 345446 ATwoo❑ 12-s4