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Permit No. APPLICATION .FOR SANITATION PERMIT ..: y- ��' Com lete in Duplicate) 1 { PDate Issued -_- �!- Application is here y made to the San Joaquin Local Healthy District for a permit to k and install the work herein described. This application is made in compliance with County Ordinance No. 549. { JOB ADDRESS AND LOCATION- .44 -G "-- }----`=-----------1 �!^ ------------------------------------------ ---------•------------ Owner's Name----,�.-�=�-•�__��-�-��------- -•-•--: -•'�-�-�'''-�------ -=---=---------------------------------------------- --- - - ------------------------------------- Address _ �.....- Contractor ---------------------------------•---------------------- --------------..-.-.-------------------------------- -, - Contractor's Name--------------=-•• - •-::---------------•--------------------------•----- •--- --• ••----- - ---------------------------------------- Phone----------------------------------- Installation ---•-------•-•---------------- --•Installation will serve: Residence ,9 Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ Number of living units: j___ Number of bedrooms Number of baths___ Lot size _ _ __. -___ ___/ ------------------------ Wafer ----------------------- Water Supply: Public system rK Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob0*0 Hardpan ❑ Previous Application Made: Yes ❑ .No�� Now Construction: Yes �. No f + TYPE OF INS7ALLATkONYAND"SPI:CIF,iCATIONS: (No septic tank or cesspool permitted if public sewer is availabE ithin 200 feet.) ' Septic Tank: Distance from nearest well__ __Distance from found�a.t.i�on_--l_L.0--------.M a toriai__t,'0_-_-t-_U44- ` __. .__._�_ - No. of compartments Size____-__ ____ __� Li uid de th__.___. ._:-- `Capacit ___ P q P. Y v 11� Disposal Field: Distance from nearest well-----------------Distance rf o oundation___ _____...Distance to nearest lot line___��___.___ Number of lines___ = _'.,_�. __._:______Length of each line__'--------------- _____..Width of trench---�-- ---------Total length-1--Rd--------------------------- i.Type of filter material--_-fW�, _.- ___-Depth of filter material--- Seepage Pit: Distance to nearest well:_ ________Distance from foundation_____----0__.Dlsta. ce to nearest lot line-- --' "-' Seer a� Number of pits------- _�- " g w ':Size:'Diameter__..r. .-------..De�tii__._---_- ---Linin material---- F P �P" - Cesspool: Distance from nearest wel€___�-=-�____Distance.from foundation--------------------Lining material__._____.__-__.-______..______-______- ❑ Size: Diameter.- t----------- -------------------Depth------ ---------- ---- ----------; ;Liquid Capacity-.- -•------ -------gals. Privy: Distance frominearest well----------------------------------------_---------Distance from nearest.building—_------------------------------ ❑ -Distance to nearest`lo$�line ----•--•-----•------------------------------------------------------- --------------------- _ -- Remod/eling a d/or repairing describe): / .. -1; '? "� ..�y �r�4 !� �ev.�.�L• �r� + ' '•' •a'-r-- f I `.+i/:. .:�.r�f °'if,+( '..•ef I'C - - -- - 1'*'a+�"-- ----- ----- ------ -- °--- air,� �fr�-_...-.��.- -!&--------- ------- ------------------------------ ---------------- - ----- ---------- {=,'------ ---•-• ------------------------------ ------------------------------------------------------------------------------------------------------------ ----- I hereby certify that I have preppy ed'this eppEication and'-that'the work willbe done`in accordance with San Joaquin County k ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.oe ' (Signed)---<--------------------- =-----•-------•---- --=--------------------- ----�------------------------------------- - - --------------- ------------------(Owner and/or Contractor) By-------------------- ...............__J------------------------------- --------------------------------------------------------(Title)------------------------------------------- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed.on reverse side). ► e k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- =-' --•------- DATE-- ` .-------- - ---•-----------------•------------ AN REVIEWED BY---------------------------------- -------- A - DTE BUILDINGPERMIT ISSUED--------------------- 4 ------------------------------------------------------ DATE-------�------------------------------------------------- Alterations and/or recommendations: � �------- _ It r _- ------ ----- v� : = -a `" :1. 1'? .�".� - ---------------- -------- -- --- -- -- - ------------------------------------------ ------------------- --- ------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- ----- - --- ---------- - f ` - ----------------------- FINAL INSPECTION BY:------ ----------------------- Date-../_e----- ------- [ J I ♦a SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oai Street j 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-2100