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' , 1 �+` APPLICATION FOR SANITATION PERMIT a��- Permit No. .-.!E_-3.��.... (Complete in Duplicate) 1 Date Issued 41 /sz_ 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------------ -- --- --- '`"' t - Owner's Namei-/''�. •------------ ------ -------------- ---------------- - ------ Phone - !:!�4 Address..."�/tc1......•--R -- --- f------- -------------------------------------------------I'll, ------ -------------- Contractor's Name--------------- ---- ------S-571LIC ------------------------------------------------ ---------- Installation -----Installation will serve: Residence 'qpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/-- Number of bedrooms ?-- Number of baths /---- Lot site __-.3---- ----------------------- Water Supply: -Public:system ❑ Community system ❑ Private [?)/Depth to Water Table AIAQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[]- Hardpan ❑ Previous Application Made:'Yes ❑ No B'- New Construction: Yes ErNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publics wer is available within 200 feet.) Septic Tank: Distance from nearest well--SP--- Distance from foundation----/�_.:------ C No. of compartments----------C-2----- ------Liquid depth. la �'---------- CapacitY = ---- Disposal Field: Distance from nearest well 47 from foundation----W4- _..__Distance to nearest lot line_...___ ................. Number of lines...:... .................. ....Length of each line-?°"'�'a.'--.7-0_-.Width of trench.____�_�_.._____________.._._ Type or filter material--s'-R)__ ---Depth of filter material-----12 -------Total length------�-� Q----------------------- Seepage Pit: Distance to nearest well.,/-----------Distance orRfo}ndation--_3a__---.._.Distance to nearest lot line----------------- Number of pias------v2-----------Lining material--&/-V-,CA---Size: Diameter---3.3____------Depth-----R-40__1---------------- ; r - Cesspool: Distance from nearest well-----------------Distance from foundation.---- ---.__..Lining material--..--.------------------------------ r\ ❑ Size: Diameter--------------------------- ----------Depth------•------------------- ------------------------Liquid Capacity------- -------gals. Privy:- Distance from nearest well------------- --------------------.'...........Distance from nearest building------------------------------------------ ❑ _ Distance to nearest lot line--------------------- ---------------------- ----------.-.-•----------------------------------------------------------------------------- Remodelingand/or repairing (describe)---------- ------------ --------------------------•--------------------------------------------•- -------------------•----- -------------------------•---- --------------- -------------------------------------------------------------------------------•-------------- ------------------------------------------------------------------------------------------------------------•--------------•--------------------------------------------------•--•--------- I-hereby certify that-I have prepared this application and that the-work will be done in accordance with San Joaquin County ordinances, S a#e laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ''v` ---------- -- - - ------- --- Owner and/or Contractor) +' By: { ----...... a (Title) (Plot plan, showing size of lot, location of system in rela 'o wells, buildings, etc., can be placed on f reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--'� ---------•---------------- DATE- - ---------------------------------------------------- REVIEWED BY------------------------- --- ---------------------------------------------- DATE- ' --- ----- BUILDINGPERMIT ISSUED--------`-- --------------------------- ------------------=---------------•-- ------ DATE--------- 4�--------- - ------- -------------------- Alterationsand/or recommendations:-- ----------- -----------------------------------------------------•-•--•------------•-----------•---------------------------------------------------•------- 1 ! f ✓ J ------ '� ` - --'------- ------ -r- -- -----�_. . ----------------------------- ` --- - - - - - -------------------------------------- -------- ---------------------------------- ----------- ----------- --------------- ----- --------------------------------- ----------------------------------------------- ------ ------------------------------- -- -------------------- -------- -------------------------------- --------------------I.......... -----------------------------I----------------- ------------------------------------------ FINAL -------- - SLFINAL INSPECTION "BY:.-- Date J. 1s ----------------------••---- 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—l' 145446 PTWooU " ' Y �