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APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate) v /fir Date issued 0? �7 Applica+ion is hereby made to the San Joaquin Local Health District for a permit t canstr}�ct andrinst ,il�rk�, rein described This application is me a in compliance with County Ordinance No. 549. �91� ��j�;;� �- ,�Z,�t,- 7 Q 2� Al D �s4-�✓!� .- �4r /// JOB ADDRESS ANQ OCAT N. -rte �_� ,_rr1. �! __. $ e- -'_- -�- - ---- 0 Owners Name--------- --- --f -.- .----------�1_�'��L-��x=s��sr�-ztl--- i ------- Phon� _� f`'•1 Address-_.... t �-a`i � � _ = '�%l.c-. ------ --- -------------------- .r__ _..-_ r `� i i a l Contractors Name_--------------------------- 0--v Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !AVO O X % 1! �----------- Wafer ------- �a Number of living units: -�___ Number of bedrooms�._ Number of baths ---/ Lot size ----______ _______._...__ __ Water Supply: Public system ❑ Community system ❑ Private 2--'Depth to Water Table ________ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 4KClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well_r �_�__Distance from foundation__1p_----......Material__.__________. -4i .._________ -No. of compartments--_ `,X ��-.x_Liquid depth_-__� ��-____.__Capacity_,00G_ -2---- -- - �----------Size_ Disposa field: Distance from nearest well..17U------ Distance from foundation__lX*.___.. Distance to nearest lot line,---- Number of lines----J_-. - Length of each line a' .S~Ct _Z -Width of trench.__� f_01_____________________ Type of filter material___ __,2._________ _Depth of filter material __LSr'` __Total length ------------------ co Seepage Pit: Distance to nearest well.---------------------Distance from foundation--------------------Distance to nearest lot line----------------- '1 ❑ {dumber of pits------------ ------Lining material----.------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well----------_------Distance from foundation. ----------------- Lining material-------------------------------------- Size: _ ___.__.______.________________- Size: Diameter------------------ ----------- -------Depth--------------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well------________'....____._.._.______..__._______Distance from nearest building--___.______.__________________._.__..._. 0 Distance to nearest lot line-- `------------ ---------------- ---------- . --•--•- ----------------------------------------------------- Re odeling nd/or repae):___ " ___ __C .___.--- _.___ �X? ----------- I - --------------------------------------------------------------------------------------------------------------------------------------------- --- v - ---- - I hereby a 'fy that I hav prepared this appli tion and that the work will be done in accordance with San Joaquin County ordinances, ate aws, a rules gulations t e San Joaquin L cal Health District. ,x E F {Signed} ---- ---------- _-.. _ Contractor) --- B -------------------------------------------- ----------- - - e - (Plot plan, showing size of lot, location o system in elat n to wells, buildings, etc., ca la on reverse side}. — =4 1 OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ---- --------------------------------------------------------------- DATE----- -- -'- ------------------- �� DATE f - - ------------------- REVIEWED BY----- ------------------ - ---------------- - - ------------------------ ------- ---------------------------------- - - -�-`r - - BUILDING PERMIT ISSUED_ - - DATE----------------- ------------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------- ----------------------------------------------------------------•-------------------------- --------------------------------------------------------------------- ------- ---•-------------------•----- ------- ------•------------------------------ ----------------------------------------------- ----•------- ------- --------------- --- ------ r --------=--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL WSPECTION BY: Date ....r/t ------------------------------------------- --------------------- SAN 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 ES-9-2M 145446 ATwoon 12-54