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-��--�- � � APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) ti $ ----- = Date Issued -_��-3.._�---. 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 A D'�-LO�CAT dA a5, -- mZ------------------------------------ - ----------------- ---------------------------------"------------------------------- Owner's Name ----------- Add '. ` 'p'' ---------- Phone-------------------------------•---- �-F—� - ------------------------•--•-- Address-----•--•-•----------- ..-------••------------------------------------------ ------------------------ ---------------- - - - Contractor's Name- ---- -------------------------------------------•------------------------.,.---------------- Phone----------------------------------- Installation will serve: Residence [+`Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑FLQOther ❑ Number of living units: _-�- Number of bedrooms _-Z__ Number of baths -]-:---.'Lot size __6-0f-�_�-- -�-------------------------_--_ Water Supply: Public system �Communify.system ❑ Private ❑ Depth to Water Table ----.--=ft. Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam Clay Loam [I Clay E) Adobe Hardpan Previous Application Made: Yes E] No 0/ New Construction: Yes o ❑ r ' TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet Se -------------- ptic Tank: Distance from nearest well�7.--..-- .Distance from foundation--f-©- ._-_.Mate_r�a�-----64w�� No. of compartments- L - -- Z ------. Size -------} lC Liquid depth` -------------- Capacity.-.- istance from foundation -LP /r�" Distance to nearest lot lin _ '_VRI � Dispos I Field: Distance from nearest well- - 1 21 Number o$ lines- ""____ -_ Length of each line-- - =Q _r.-.Width of french"--.----- /�"-- _--t--.-_-- Type:or filter mate epth of filter material-------- ____--.Total length_-_------------— ------_--..- Seepage Pit: Distance.to nearest well----------------------Distance from foundation-------------:-------Distance to nearest lot line--._----__--._.-_ ❑ Number of pits---------- ------Lining material-----------------------Size: ❑ Diameter---..------------------Depth--------------------------------- --------------- Cesspool.. -------------------------------. _---------._.Cesspool:. Distance from nearest well------------ - --Distance from foundation--------------------Lining material---.--------__.___----. Size: Diameter'--------------------------- - ------Depth-----------,:---------------- -'--------------------Liquid Capacity-------------- -------------gals. ` i .-----:_.__Distance from nearest building------__-.___-----.- Privy: .. Distance from nearest well --------- ---•:-T----------_ - -------------------- El ------ ❑ —Distance to nearest lot line ------_--------7----------.,,.-- •------------------------------------------------------- ---------------------- ----------------------------- ----- 7 Remodeling and/or. repairing (describe):------- ------ --------------------------------•--------------------------•---•-----------------------------------•------------------ ----------------------------------------------- - ---- ...-------•-•------------- - '-- ------------------ ----- --------------•----------------------: - - -----------------------------------------------------------------------------------•---------------------------- - - ---------------.----- -------- I hereby cerci#y that I have prepared this application and that the work will;be done in accordance with San Joaquin County f ordinances, State laws, and rules and regulati ns of the San Joaquin Local Ifh District. t - --- -- -------------------------- --------- ---{(Owner an or ntractor) (Signed]' �--�- ------'-�-x---'--r--• ------r�----- -- � -. - ---- ---=--- O d/ �t" 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 r ' APPLICATION ACCEPTED BY DATES'---------------------------- --------- --------- REVIEWED BY- -DATE- ------------------------------------------ ------- -- I BUILDING PERMIT ISSUED........... --------------- - - DATE �� Alterationsand/or recommendations:------------------------- ------------------- •---------------------•--------------------------------------------------- --------------------------------- -,, ------------------- y ...............•------__._--------•-_•_-------------------•- ' --./----------------------------------------------_.----------___-"__----------___. -----------___-__-----_.--_.------_--__--.-----•-• FINAL INSPECTION BY:w _ ----------------------- -------------------- ""� Date.-. 'f-d-------j---L---- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Syeamore Street 814 North "C" Street 9 Stockton, California Lodi, California Manteca, California Tracy, California 9 ES-9-2M 145446 A7WOOD iz-sa