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vl 'lI APPLICATION FOR SANITATION PERMIT Permit No. V 3 5~ (Complete in Duplicate) YDate Issued -- 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 L ATI Qf --------- �J-- ---_ , ------- --- ----- --- - ---------------------------------------------------------------- Owner's Name---- ---- ------ -- - -------- ---------------- ------------------- ----------------------- Ph----- on e,/.t=rte'-•--------------•- Address-.. -- ---- --- ------- _ - Contractor's Name----------- ---- = ��s - ------------------------------------- --------------- ••- ------------------ Phone --------._�45� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court p Motel [] Other ❑ Number of living units: .-- Number of bedrooms _lf_ Number of baths aZ__ Lot size __ _•____ W Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table "' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel FJ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes MNo ❑ New Construction: Yes K No ❑ / 1�� 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. +? TDistance from foundation_-___ ___� Mat�ri�}i_S No, of compartments _Size �. _____Li Liquid de th___ _- 1' - 4P q P. _ ---.------.-Capacity... 1 Disposal Field: Distance from nearest well��-D`-0.' Distance from foundation___________________Distance to nearest lot line!. ___________ Number of lines----------/-------------- -- Length of each line------��_f-_- -_ Width of trench---- / ----------_-__-- --- Type of filter material __ _______ p " � - --____Depth of filter material----��----____---Total length------•,,.�,�-----------------•__-- Seepage Pit: Distance to nearest well ____Distance rom f ndation____ --------Distance to nearest lot line___! Number of pits Lining mate ria#2 -..Size: Diameter------- ----Depth-- " ' 1_t:l Cesspool: Distance from nearest well_________________Distance from foundation.---_---------------Lining material_____.--_________----______--_ ElSize: Diameter-------------------------------------Depth----------------------------------------------------Li uid Ca aci q p tY gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------,___-___-_ Distance to nearest lot line----------------- -------- ---------------------- Remodeli and r r p ring (describe):_ Pr ,----.. �- � Z -- 1Z--------- - ------- _ ---- ---- ------ ------ -.-- --f .... – ----- ,----•----•-- - Cie a••'°2----------------------------------------------------------------------------------------------------------------- ----------------------------------------------•-------------------------------- ---------------------------------------------------------•--••------------------- ------ --------------- ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andV-34-1- and regulations of the San Joaquin Local Health District. Si ned ----- Owne19 } -- • - dor radar) By:------------------ ----- -----•---- e roman, Contractor) (Plot plan, showing siz of lot, I cation of system in relation to wells, buildings, etc., can be.`placed on reverse sid#). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- , DATE ------------------------------------------------- REVIEWED BY � ---------------------------------------------------------------- -------------- DATF -------•--•------- -------------- ---------------------------------------------------- ---------------------------------- DATE------��---------------------------------------------- BUILDING PERMIT ISSUED Alterations and/or recommendations-------- ------------ ----------------ii----�------------------------------------------------------ ------------------------------------------------------------•--------------------•------------------- il ------- --- $/-------- ----------------------------------*------------------------------------------------------------------------*----------------- - FINAL INSPECTION BY---------------- ------- ------ ! •-- -- ------------- Date...IV)-------7. 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 Revised W-2100