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• sx_ APPLICATION FOR SANITATION PERMIT.- Permit No. {Complete in Duplicate) ( Application is hereby made to the San Joaquin .Local Health Di Of Date Issued This application is made in compliant with County Ordinance o. 549. strict for a permit to construct and install the work herein described. ZAP Z-�=- f�C6-moi,/ '� JOB ADDRESS A" ATI Owners Na -- - 21 ,�� _. __•_ --- r ---- ----- ss.__ -- ss. . ..Addre --- -`-- . onU, Contractor's Name_ � � "` •�. - ' j' J r' _ �..-- 4- ______��--"--"-----"""""��---""---�� -- ----------- Phone___"- Installation will serve: Residence �-- ❑ Apartment House ❑ Commercial Traile Court Number of living�unitsJQNumber of bedrooms • " 0 Motel Other ❑ r �_ Number of baths - Wafer Supply: Publics stem Lot size - _ } Y ❑ Communit s stem 1 r '- ='_• Y Y ❑ Priva te�Depth to Water Table— {t Character of soil to a depth of 3 feet: Sand Previous Application Made: Yes ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ❑ No New Construction: Ye ""Nb ❑_ TYPE OF INSTALLATION -AND SPECIFICATIONS: Imo" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N ZSetic`'Tank: Distance from nearest welt""-" __.. ` Distance from foundation_:.---------•-_: Ma.teriaJ__.--•-------� � No. of compartments_.__" _" -" y Size ----------------_-----_Liquid depth-------------- -----------Capacity_-w - �� f Disposal Field: Distance from nearest well ____,-----------Distance from foundation____________________Distance to nearest lot line________.___-"•"" -/��%�.jj Number of lines----------------------------- . . U Length of each line___"_____._"._-.----_-_-----_Width of trench-_.--"-_- f , a Type of filter material_______"- " _ ------------Depth-of-filter material----------- ------ ------ ` �/ Total length------------------------- ----------- Seepage ----------- Seepage Pit: Distance to nearesxe, ll----/ _" Distan rom foundation"" "" V ! i e -•-----.Distanfe to nearest jo line_-__.,;,y - Number of pits- ---- ---------Lining material,__:,f�_��-----Size: Diameter-----� ____ Cesspool: Distance from nearest well _______"_Distan Distance from foundation_____"-""__ -"- Depth--- ------------ Size: _-- Lining e ❑ -. Size: Diameter_ - . .....Depth ------:- - - m material ----------------- Privy: gi ---��_» '-'.. '"'. "`�` '�•-'-.. _. -: -.�-_�- --�=-_LiquidYCapacity.-=------•---- ., Distance from nearest well--------------- ----------gals.' -------------------Distance from nearest building _ ❑ Distance to nearest lot lineg-----""-____.-___"-- -" -------------------------- ---- - - ------------ Remodeling and/or repairing (describe): i � � - r -------------------------------------- .. ,. , ------------------ --------- ---- -----------------------•--•-----------•-- -------- 3 ------------_-------------• I hereby certify that I have prepared this application and that the work will be done in accordance`wi#h'San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfricf. (Signed) Y By:---------------- -----_I--------�--------- _ Contractor) �. , ------ and/ (Owner and/or tort (Plot plan, showing size.of to location of system in relation to wells,-buildings,,etc., can(biel placed SQ Side. `---- "- --- ----------- ---------------------------------------------- - ----- F I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------_°""-"._"- " REVIEWED BY----------- -- /---lei__ = - --- DATE �- - ------•------- ---------- ------ ----- --- BUILDING PERMIT ISSUED_. ------------------ --------------------•------ ------ DATE-------------------=----- --- -......-- ------------------ ------=------ erafions and/or recommendations:------------ DATEAlf --_.---•----------- l - ----------- FINAL INSPECTION BY: -_-------t._.,------ _ (j\\w �( ------------ Date------ - ' -- ----------------- - ______ ----------------------------------- ---- SAN JOAQUI'N LOCAL HEALTH DISTRICT J30 South American'Stree} 300 West Oek Street 1 Stockton, California 32 Sycamore Street; '914 North'"C" Street ,4 Lodi, California- i Mentece, California ^ •) i t + Fo,S� Revised w-zioo �` `... Cyt