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Permit No. g 3 Ss Ff APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued L +ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica This application.is made in compliance with County Ordinance No. 549 JOB ADDRESS AND .LOCATION ---+5 - ----------------- -----------•---- LL /) /� ,,,� ----------- Phone-03,575-1-1 Name---Sh-6-4--p-=----- /_.! = ~ . 1t'j erSd�--•------- ---------- --------------------------------------- Address -•--•----------------------- Address.--- --L- ------------------ -- - ---- Phone----------------------------------- 4 Contractor's Name_--- - i —14 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mitel [) Other ❑ a tl ------- Number of living units: _-___.-_ Number of bedrooms _-�_-- Number of baths ____ILot size ..-- I Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table - ft Adobe Hardpan F I Gravel Sand Loam ❑ Cla Loam Clay ❑ ❑ P ❑ Character of soil to a depth of 3 feet: Sand ❑ w ❑ Y Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic +ank;or cesspool permitted if public sewer is available within 200 feet.] r- ��-0istance from foundation___ ._O__-_____--.Ma�erial.___1-�- -�AIO --- ---------- Septic Tank: Distance from nearest well____.__._.____ � " Ca acit eQ -I No. of compartments a--------------Size---7- .' .� Liquid depth l p Y Distance from foundation__._f_ r.Distance to nearest lot line--.. Disposal Field: Distance from nearest well_.—r -- �� _ Nu' ber of.lines___._-____ -- Length of each line_...°_.-.W- ----.Width of trenc - c- ------------------ -- Total length-------•;ZJ------------------------ Type-orfilter material___._ -c--Depth of filter material__-__-/V------- n a f} ,_.___.Distance to nearest lot line__ _ ____- Seepage Pit: Distance.to nearest well___.__ --�=Distance from fou ation____. ..t Size: Diameter- Depth o?cr Number of pits___.__.'____----"----Lininq material T � . Cesspool: Distance from nearest well---------.-____-Distance from foundation___________________Lining material------------------------------------- ...Depth------------------=-------- Liquid Capacity-`---------------------------9 ❑ Size: Diameter-- Privy: Distance from nearest well--------------------------.------ -_-Distance from nearest building_-_-____--_----------------------------- .R ..1 . ------------------------------------------------ . ._ - . m ❑ est lot line:--"-------=------------------------------------------------------------------ Distance to near k Remodeling and/or repairing (descr be):------------------ ---•----------•-------------------- --+ •-----•--•--------•------- 4 -------------------------------_----------------------------------------- ------___________".___"_-•-_-___________..____.____.____. ---------- ___--._...__'__ _______________ "__---------_------------------------------_------------_-------------------_----------_ - I hereby certify"that I have prepared this application and that the.work will be done in accordance with San Joaquin County 4 1 ordinances, State laws-and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) lan` �show'i size of I (Title) ------------ -------------------• I (plot p lot, location of system in relation to wel{s, buildings, etc., can be placed on reverse side]. showing � c FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I -------------------•---------•------------- DATE. �•-- S---->------------------- ------------------------ - -------- 4 DATE �_. REVIEWED BY `- ..-- - - DATE----- -----------------------------•------------------------ BUILDING PERMIT ISSUED---------- .__ ---- -- w f :•..�-------------------- ............ ns_ _ _______ ____________Alterations and/orrecommendatio ------•--------- f/ �_y� O ------------------------------------ ly ----------;-------- "------- --- ----------------------- Date.. / -5 ---------------------------------------•--- FINAL INSPECTION BY:.^. _ _:';�--'_�-------- , t/ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street ` � Trac California Stockton, California I Lodi, California Manteca, California Y� FS-4-2M Revised W-2100 _. -