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l 1 APPLICATION FOR SANITATION PERMIT Perm\/No. ------ cL (Complete in Duplicate) Date Issued.. +' is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described: Applica ion Y ; This application is made in"compliance with County Ordinance o. 549. ------- JOB ADDRESS A�91OCATION-------------------------- (� `�,-5 i --•-- -- ----------- -- ---- ----------------- Phone --- --------------------- --------- --- ---- •-------- Owner's Na rf --------- - - - - ------ ------ - -- -------------- V �� -- Addre f�C __�-- j-0_7 . � --- •------------- Pone_ -- -------• --- Contractor's Name__________________ ___ - --------p ----------------- Installation will serve: ' Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ cc}� --- Lot size ------- --- ----------------•- Number of living units: __/ Number,of bedrooms CX_ Number of baths . _-- Water Su I Public system ornmunity 'system ❑ Private ❑ Depth"to Water Table S ft- Supply; "t. PP Y� y g� (Adoberdpan F1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F71 Clay Loam ❑ Clay ❑ Previous Application Made: Yes E1 No P-,'New Construction: Yes E] No TYPE OE INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Y_n ' �.1'-- Mate ial .-'- Septic Tank: Distance from nearest well-----A& Distance from foundation___ r / Capacity -- -------=- No. of compartments--__-- Size_ - -_- - -------Liquid depth--- -----" p Y " �_Distance from foundation_.__---------Distance to nearest lot line_` --.--U--- I Disposal •ield: Distance from nearest well`2L0.k% S'� r Width of trench______- - r Number of lines---------/_-_--- --raj Length of each .ine,-- ------ ---- ----- - Type of filter rrnaterial--�1__ - _04� Depth of filter 'Mater�a4_._...-1-�".------dotal length-----5�---•---------- r te' Distance from foundation__.-----a---- .Distance to nearest lot line.__`r---.--"- Seepag it: Distance to nearest well.----------------- --- Size ---. --��--- -._.Depth---, --------- Number of pits:_--_._./-_----------Lining material__ --- ' Distance from nearest well_________________Distance from foundation._-- Lining`material__..___ Cesspool: Liquid Capacity----------------------------gals. ❑ size: Diameter"- -:----- '-------------------=�Depth:----�:_----- ----�--- :------ ------ ------- - q Distance from nearest building------ Privy: Distance from nearest well --•-------------------- ❑ ----------------------------- t ------ --------- - ---------------------------------- • Distance"to nearest lot ine.__---"----------------- _ ---•------------ e Remodeling and/or repairing (describe: 4 .- ---- ----+----------"r'- ---air_. ' --------------------------------- ---------- _- __________________i_ __ _ y y that I have prepared this application and that the'work will be done in accordance with San Joaquin County 1 herebrtif ordinances, to I s, and ru bs and ulations of the San Joaquin Local Health District. Owner and/or Contractor) s (Signed) -----•;----- ----- -------- a- - - iTitle) ----- 1 By: ---------------- -- (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY } DATE_ = APPLICATION ACCEPTED BY_. ---- _ DATE__ ------------------------------------------------- REVIEWED BY--------------- -------------- ------ --- Vx------•---------------------------------------- BUILDING PERMIT ISSUED------------ - •---- DATE- 45 ----- ---------- --------------------------- Alterations and/or recommendations-------------- --- -- ...... •------- i----------•----'s------ --------------------------------------- --------- -�c 1 ----- i----------------------:---------------- .... --------------------------------------------} --------------------- LS'� ------------------ .n Date-------- ------------------------------------------- FINAL INSPECTION :------�-�-------- -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street 132 sycamore Street 130 South Amario'an Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California �s—y 145446 ATwpno - .. --