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pGl / APPLICATION FOR SANITATION PERMIT Permit No. ___..�_0_-/-la... (Complete in Duplicate) v) Date Issued Appiica{ion is hereby made to the San Joagµ'��pp,Local Health District for a permit to construct and install the-work herein described. Phis application is made in compliance i# Cad ty Ordinance No. 549. JOB ADDRESS AND L CATION--- ..1.T/---------------------�---------------- ----------- -------...--------------------'----------------------------------- - - . w. - e�a s-4 37 Owner's Name//........ �y _ . .t.. 1 "� r - - - - ------------------ Phone Address-.------1•e -•------- '-J--------------------------------------------------- / Contractor's Name---------`E __ --- --=--- .C�-------- ----------------------------------------------------------------- Phone_ !�-"!e r _ Installation will serve: Residence ©�Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living-units: _/___ Number of bedrooms _� Number of baths __/___ Lot size ------------------------ Water Supply: Public system [�Cgmmunity system El Private ❑ Depth to Water Table �� ft. ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No H] _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well�2fVLJ-_Distance- from foundation---14--------.Material- No. uter I_No. of compartments______.._ _ sG X---- �-- _Ca acit Disposal Field: Distance from nearest well... .. .........Distance from foundation__ Q_._-------.Distance to nearest lot line___.._____ Number of lines------- of each line___.. ~—_______;_______.Width of t rench._..__. ____________ Type of filter ma+aria)_-�� _ _De th-of filter � RTotal length- --__-____________________ Seepage if: Distance to nearest_ ll_7-__Distancerfrom foundation_..,Z4j.. _.___.Distanciei to nearest lot line..__ Number of pits._.__-_!_-___._______Lining material---/4�8 _ Size: Depn_ ---- ir _______-____,.__:_ Cesspool: Distance from nearest well-------------_---Distance from foundation----------------.__..Lining material_-_____..___________________________ \�• ❑ Size: Diameter------ =-------------------- ----------Depth------- -------------------------- -----------------Liquid Capacity---------------------- gals. pV Privy: Distance from nearest well--------------------------------------__-------__Distance from nearest building------------------------------------------ El ________.__._-___-.-..__________._ ._❑ Distance to nearest lot line-------- ------------------------------------------------------------- -------------------------------------- ----------------------------- Remodeling and/or repairing (descri6e):------------------•-------:--------------------------------------------------------_--------------------------------------------------------------------- ------------------------------------------------------------------ ---------------------------•-- _--------------------------------------------------------------------------------------------------------------------_------------•---------------•------ ------:---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,,'%ite laws, and rules gulations of the San Joaquin L c I Health District. c_-_ _ _ __ �_ ._. ._ Owner and/or Contractor (Signed)-- = ) -- - - ------------------------------- -- - B (Title) -- - ------•---------. -------------•----------------- - ----- (Plot plan, showing size of lot. Ioca+ton of sys+em in relation to w7eiuildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ .. DATE____________________________________________________ REVIEWEDBY-------------------------- ----- DATE--4.1�------------------------------------------------ BUILDING PERMIT ISSUED ----------------------------•------------------------•------•--------•--------------•----- DATE 4' Alterations and/or recommendations:_'.------------------- ------------------.. ----------------------------------------------------------- ------------------------ I -•-•------------------------------------------------------- ----------- ---------- - •------- -----------------------------------------------------------------------.....--•------------------•--•-----•--------------- E ---_------•--------------------------------------- ------------------------------------ ----- ........ ------------- --------------•---------------------------------------•----------...---------------------- FINAL INSPECTION BY:- y- �___ __ - _. - ---------_------------- Date---_.. ""'' SA 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 E5--9 745446 ATWDOD