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APPLICATION FOR SANITATION PERMIT Permit No. _ - ` (Complete in Duplicate) Date Issued L 6(7-01-70-- O� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ork h rei escribed. This application is made in compliance with County Ordinance No 544. f � ,-�-- JOB ADDRESS AND LOCATION_-Zht' - -- --------------0Z Is---- --------------- ------------- - ---------- Phone------------------------------------ Owner's Name----------- -C Address �_ 1✓ r --------------------------------------•--------------------- --------•----------•--•---------------•-••---- Contractor's Name_. . - . �/= -----------------------•---------- Phone------------------------ --- - - --- --- --------- Installation will serve: Residence '�. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/__.. Number of bedrooms _ .- Number of baths /-_.__ Lot size ..-- - J= -----------------------•- Water Supply: Public system ❑ Community system ❑ Private 2"t-epth to Water Table '�aft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No - New Construction: Yes to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �dion_-- - ------ -Ma er�al = '_` Septic T nk: Distance from nearest well...: _d---------Distance from found�t - - No. of compartments_-_- -.-'7 $ize__ i - Liquid depth ---------- --------Capacity Disposal Field: Distance from nearest well._____-..._Distance from founds ion 147-�� Distance to nearest lot line_._ — L� ---_ Length of each -d--Width of trench..._ --------------------- Number of lines------- --------- � 9 Type of filter material.---J..) - ---. epth of filter material_-_�.g._1 __...Total length_._____J. _____________________7 Seepage Pit: Distance to nearest well--------------- ---Distance from foundation--------------------Distance to nearest lot line----------------- G El Nbof pits.-- Lining material--------•------------- Size: Diameter-----------------------Depth..---- ------- •----•---------- "% 41* Cesspool: Distance from nearest well-----------------Distance from foundation_-- ------------ Lining material-----------------------------------l__. ❑ Size: Diameter----- ------------ ------- -----------Depth---------------------------------------------------Liquid Capacity --------------•---gas. Privy: Distance from rearest well-------------------------------------------------Distance from nearest building--_---------------------------.----------- A ❑ Distance to nearest lot line-------- ----------- -----•--------------------------------------------------------- •---------------- - ------------------- -------------- Remodeling and/or repairing (describe)---------- ---------------------------------k ----------------------------------------- ______________________________________________________ f -------- - - -- - ---- - ------ ------------------- -------__--.-------------------------------------._-.____.._.---_---_---_-------__-_-__.-_----_-__---....----____-_----____---__--_----...._.------___--._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State.laws, and rules and regulations of the San Joaquin Local Health District. ----------------------------------------(wand/or Contractor)W Signed _ 7) - ---� -------- ------------------ --------------------------- ...... - - - ------ --- (Title)-------------------------------------------------------------- --••--------•--------- --- ----- -- (Plot plan, sh\ying size_of lot, location of system in relation to.wells, buildings, etc., can be placed_on-reverse side). a Y= F R ,Iv`IENT SE ONLY APPLICATION ACCEPTED BY--- --- ..._ - --- - ----- -- -- --- ----------------- ----- ------ DATE---- -- - - ---------------------- l REVIEWEDBY------------------------------------- -------------- ------------------------ ------------------------------------------------ DATE----------------------------------------------------------- { BUILDINGPERMIT ISSUED--------------------- - --- ---------- ------------------------ ---- ------------ DATE------------------------- •---------------------------------- Alterations and/or recommendations------------------------------ --- ---------------------------------------------•--•------' ------------- --------------•-----------•---------------------------- --------------------- ----------- ---------------------------- -------------------- --------------- ------------------ - ----------------------------------- DIP � --------------------- Date---- --- ----- ------- ----------------------------•---- FINAL INSPECTION BY:._..__._-r..:...........(It SAN JOAQUIN LOCAL HEALTH DISTRICT ' `k 130 South. American Street 300 West Oak Street * �Imvanfecs, 32 Sycamore Street 814 North "C" Street California Tracy, Califprnia �,, -Stockton, California Lodi, California