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f APPLICATION FOR SANITATION PERMIT Permit No. " - --------- (Complete in Duplicate Date Issued Applica%n 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 ADDRES�AND LOCATION � - .:- -r4 -�rx� ��. - f Owner's Name - +4 - -� " ----- j ------------------ --- ' ------- --- ----- Phone-.--- Address---------- �1 ,? _ ' ��i, ontractor's Name---,---....----•------- -------�... ------------------------------------------------------ '-- - -•-- - - ------------ Phone- -- -- - - - nstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/-.. Number of bedrooms -;?,(.- Number of baths j---- Lot size _ Water Su I Publics stem 4 'r PP.Y� y ❑ Co— w' system ElPrivate eDepfh to Water Table -------- ft. Character of soil _to a depth of 3 feet: Sand❑ Gravel ❑' Sandy Loam i Cla Loam Cla Previous Application Made: Yes E]It No New Construction: Yes IJ NoE] Y ❑ y El Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic sevrer-is available within 200 feetlll Septic ank: Distance from nearest Well4o , '-- Distance fro. fountion-, --.--___---Mat rial--- -- -- --,--'---- F," No. of compartments- .-- ___...._- SizerC, -_ Liquid depth_.-_--- _ -------- Capacity-•- Dispos Field: Distance from nearest well-.___-Distance from foundation_---- U-_�..... Okt_r6 Distance to nearest lot line.------- Number of lines----:--•------1--------------------Length-of each line_------._�'Q---'.-----.-.Width of trench-.-------2- -"-'- f Type os filter material------ - ----Depth of filter material------T!j�....-.....Total length-----------------s^d-------- - Seepage Pit:.,-, it: ` Distance to nearest well -_. ' Distance from foundation--------------------Distance to nearest lot line ❑ Numbe _ r of pits.--_----- ---__--.__-Lining materia)--T---_-------------- c' maize: Diameter Depth --------------- Cess ool; p Distance from nearest well"----------------Distance from foundation----- material---.-------__ ------- Size: Diameter.------ - ----------- ----------------Depth---------------------•----------- ----------------- ' Liquid Capacity-'---------------- --------gals. Privy: Distance'frc�m nearest well-------- ------------------------------------.-Distance from nearest building ElDistance to nearest lot 1ine-------------- g ------:----------------------------- ----------------------------------------•----------------•--------------------------------------------- Remodpling and/or r.1pairing,-(Jescri a):---ri::� - ------------------ ------------------------------------------- ----------------- ------ -------------------- -- 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, and rules and regulations of;the San Joaquin Local Health District. (Signed).— =- /�5_,C- (Owner= -----' -•---- ---------(Ow and/or Contractor) By:----------------••-------------•------------•-------------------------------------------------------------------------------- ----(Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-�. ---------- - - - ---------- ------------ DATE - REVIEVVED BY ---'---------- -----'-- - ---' -'-'------' ---- - - `' .�---------•---------------'-•---------•-------------•- --------------- ------------ ---------------------------------- DATE-�' ' BUILDING PERMIT ISSUED------------ -__ --------------------'----------------------- ------------. DATE-------- -- Alterations and/or recommendations:.------'- --.- ----------- -- -- ------•------ a x- �,r .---- -•----------- ------- --------------- - lo FINAL INSPECTIONBY:-----'-----------------'. /� —lel} " ----'- ----- ' ------ -- ---- Date. -'- SS------'--•-- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 S*Wh American Street 300 West Oak Street 132 Sycamore Street Stockton, California - 814 North "C' Street --Lodi, California' Manteca, California Tracy, California ES--9-2M [ gsgq6 ATW000 1354