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�1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �0�-+4•!J�}-- LTJ -j Date Issued ---------�....----.. Applica{ion is hereby made to the San Joaquin Local Hea€th 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 AN OCATfON --------a - - - ,�` /---------------------- Owner's Name a _ ? P on - --------- Address-- l� Address G a r _Z_—r'`l — .� ;,. ----- -- -- -- ------ - Contr cto-is Name.---- ---� - --- --- ---- �----- ----------------------------- ------•---- Phone--- Installation will serve: esidence Apart nt House ❑ Commercial ❑ Trailer Court ❑ Motel they ❑ Number of living units: ___ Number of bedrooms��._`Number of baths,-G__ Lot size _ "•_ ^ =- -- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabla�_�_ .�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: YesZ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepptic n : Distance from nearesi we€l-----------------Distance from foundation--------------------Material ______--__-_._______________________..__-____-_.. No. of compartments-------------------------Size-------------------------------Liquid depth--------------------------Capacity_-------------------- Disposca F d: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_______---______- rNumber of iines-----------------------------------Length of each line------------------------------Width of tren�h----------------------------------- /✓ Type of filter material_________________________Depth of filter material-----------------4_____Total length__.--___.__________________________�__-- See act Pit: Distance to nearest well_, [ _-___-__pistance orp f ndation�a_____....Distance to nearest lot line____--- Number of pits--_.--------------Lining materia _ _- ____--_ -_-Size: Diameter__._ ? ----_.___.Depth_ _ - f Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-------- ___.________.____________-- ❑ Size: Diameter-------------------------- -......Depth----------------------------------------------------Liquid Capacity-------t--------------------gals. Privy: Distance from nearest well____ _____________________________Distance from nearest building------ ---------- _____________-___-----_ ❑ Distance to nearest lot line--- ------------------------------------ Remode#ing and/or repairing [describe):--- �� - � `" s' - ------------ --------------- --------------•----•-- .� - - - -- ----- --- _.--- -------------•------- ------------------------- ----------------------------------------- •--------------------------------------------------------------------------------------------------------------------------------------------•------ --------------------------- I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules an regulations of the Sa"Joaquin al Health District. Si ned � � _'-[ g )---�- -- -� - F ----- - - ---- ----- - '�---- -- ----------------------• --- -------------- {Owner Contractor) BY= •'. .. = �� [Ti#le) ------- [Plot plan, showing size�af9lot locati n of s st in relation'+o wells, buildings, etc., can be p o�n re s se $idef} FOR DEPARTMENT USE ONLY REVIEWED BY---------------- ---------------- --- ------------ bA7E__.__ tU - - APPLICATION ACCEPTED BY------- --- DATE------ --� pp ----------------------------- BUILDING PERMIT ISSUED----------------------------------- ------ DATE.--------------------------------------•-------------------< Alterationsand/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------- --._.t k _______________________________________________________________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________--_____.____..-_____...____._..__________-___-____-.__-__.._._...__..__--__.___-_.________.___.______.___________-_---___-__---_-_._..----__________._______..______.--_____..___.______-____________--_______ FINAL INSPECTION BY:.... .1 ------------------------------- Date--- -------------------------------------------------------- SAN --_"------- --5SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revssed W-2100