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APPLICATION FeR SANITATION PERMIT Permit No. ------ !?�::-fl.. (Complete in Duplicate) �� / Date Issued ___�I___S______- ^ Application 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 Counfy Ordinance No. 549. p JOB ADDRESS AND LOC TION--- ------- ""_. � /f-`7------��r1'----- ----- -- ---- ^-.�4.--,►---------------------------- Owner's Name. _: T---- Y -- ��lr -- -- Y Phone-- -d9 - ..--• -•- ------------ r -- -- ------•------ Contractor's Name_ .. ------- Phone.- '.aS Installation will serve: Reside ❑ Apartment House ❑ Commercial ❑ Trailer Court [4 Motel ❑ Other ❑ Number of living units: 4.5-r—Number of bedrooms ________ Number of baths -------- Lot size -----------___F--C —AV ------------------ .____ Wafer Supply: Public system ❑ Community system Z Private ❑ Depth to Water Tabled l3(ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [) Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 14 New Construction: Yes R& No ❑ 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 15n�___Distance from foundation__.___ QE__.Material__/-_---- _'_ __________________ J No. of compartments-,er-3----- --------- -Size------------------------------•-Liquid depth---------- ---- - ------ -Capacity----------------------- Disposal Field: Distance from nearest well--.# istance from foundationDistance to nearest lot line_-_--__..__...._.�� 91 Number of lines____________ _ �, _ _Length of each line________ Width of trench.__ ..__ s --------------------- Type of filter materiaL_____�'_t- __ _ _Depth of Filter material_._.__1.)_l.__,_____Total length----------- ___________________ I •Seepage Pit: Distance to nearest well_______________ _______Distance from foundation-------------------.Distance to nearest lot line__.__.___..______ + ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Deptn---------------------------- Cesspool:. Distance from nearest well________.______Distance from foundation--------------------Lining material------ ____ ___________..._________ ❑ p --- --------------Liquid Capacity------- ---------9 + Sipe: Diameter- ---------------------------------.De th-------------------------------- els. ' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________.______________ ❑ Distance to nearest lot line-----------------------------------------------•--------------------------------------------------------------------------------------------- RemodelinC� and/or repairing (describe):______ ___________ _ G�G f r - -- J ______�._--___ /[Z --�y-� 'i p a � - �l f `eI----- - - -.5.. L..?_. __/-___1/eA �'3-------•------ ------ i y � Cll._ 1--�_-g---------Vy-`� �- _ --r-----. -t`----------------------------------------------------------- ---- --- r ---- -`�---- - -------------------------------------r------------------------------------------------------------------------------------------------------------------------ --- -- -I------------------------------ - 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 an regulations of the San Joaquin Local Health District. (Signed)---- .... ---�----- ---- - -- --------------- ---� ---------------------------------------------- - (Owner of d/ar Contractor) By:...... _ - ------------------------------------------------------------------------------------------{Title)----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________ ____ _____ `� �-- � ___- ^ ---- --------------------------------- ----- ------ -------- - - DATE---- -1---- �----- --•---- ---------------- ' REVIEWEDBY-------------------------------- ------------------------------------------------------------------------------------------ DATE--------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendafions------------------------------------------------------------•----------------------------------------------------------------------------------------.---------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------•--------------------------------------•--------------------------------------------------------------• ---------------------------------------------------------------------------••---------- ------------------•------- -------•--------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ---------------•-----•------------------------------------------- - ------ ------ ---------------•------------------------•-- ------------------------- ----- FINAL INSPECTION B '� / �i �j -- ----------------•--•------------------------------------ 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 E5-9-2M 10-52 Revised-W-210D` � r