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APPLICATION FOR SANITATION PERMIT Permit No. -_- --.:5 (Complete in Duplicate) '/ „ Issued . ` Date ! .j' Applica+ion is hereby made to the San;Joaquin Local Health'District for a permit to construct and finstall the work herein described. This application is made in compliance with County Ordinance No..549 - �. JOB,ADDRESS AND LOCATION- ----- ' O --------&IR. '0-1ad -141 VIZ 7L- Owner's Name------ h� /. Q + � ----------------=------- ------------------- --- ------------ -Ph�n� Address-._._, ---- Conte -- f actor's Name..- + - /z --------—=74/4 r------------------------- •-•-----•---------------------------- Phone. Installation will serve: Residence ❑ Apartment House ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _� Number of bedrooms __ Number of baths _—. Lot size --__________________________ Water Supply: Public systemCommunity system ❑ Private'❑ Depth to Water Table _j;Cft. Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe> HardpanF❑ Previous Application Made: Yes ❑ .No $L New Construction: Yes ❑ No'4 t TYPE OF INSTALLATION AND SPECIFICATIONS: I r• (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- "No ----_.-------------_-..---_------_------ `. No. of `compartments Size -------Liquid depth--------------------------Capacity tY - .•Distance from nearest well ------_-.:._:Distance from foundation---------------- Disposal Field: - -_.Distance to nearest lot line------ --- ❑ Number of lines-----F----------------------------Length of each line-----------------------------. Width of trench-------------------------_--- -- Type of filter material------------------------°Depth of filter material----------------_j----Total length--:---------------------------------------- s _ Seepage Pit:"_ Distance to nearest,well_1Vf 1YC*---Distance from foundation-IS.".._.---Distance to nearest.lot in e--�-------_ i Number of pits._Q_l4l�____--_Lining material_SRIV<.....:Size: Diameter-- ..............Depth_ -----__--..___-.__--__1 Cesspool: Distance from nearest well----------------__Distance from foundation-----,------ -__--,Lining ------------------------------------ El Size: Diameter.....-_-•-------------------- ------De th------------_-._.p--------------------------; -.Li ui.d Capacity __gals. . I Privy: Distance from. nearest well .'------------------------------------------------Distance from nearest building ►� ❑ .. - est'lot line------------ - ----- -------------- ------------------- Distance to near ---- w F -------------------------------- � Remodeling and/or repairing (describe)--------- ------------------`------------ ----------.--�--•-••-•---•-------•---------------.----------------------- --- ---=-----------------------------• •------------------ ---- -----------------•-------- --------- -- ------• ;.. - - -----------------------------------------------------------------------------------------------------------------------------'___---_-_-------------------_--..--------_----_.•_-•-------------_ ------ I -hereby.certify that I hav p6pared this application and that the work will-be-done in accordance with San Joaquin County ordinances,_State laws rules � d reg I�tions of the San Joaquin Local Health District. ' _ -—----(TitIe)(Sign�)---------------------- ----o----- -•--.- --•- nd/orContro Contractor By _). --- ----- (Plot plan, showing size of lot, location of system in relation to well , buildings, etc., can be place on reverse side). I FOR DEPARTMENT USE ONLY 1: APPLICATION ACCEPTED BY ---------- ----------------------------'- J�, ----- ---•-- ----------------- TE------------ - —� i _ --- -_ ...-----=---------- REVIEWEDBY--------------------------------------------- ------------------------------------ ---- ------------------------ DATE TE------ ----- i BUILDINGPERMIT ISSUED-------------- ----------------- ---------------- ---------------------------=---------- ----- DATE--------------------------------------------------------------- Alterations and/or recomritendations:__Nt__----------------------------------- - `" •-•_-•-•----_-----•--------------•__-----_-__---•---•------_---____F____-------_-_----------------------------------.-.------_--------___•-_-__-_••-----•--_--_-_----_-__--_--_--___-•-_-_--___-_-- ..-......-._.---• -____-_._..._-___--------------------------_----__-__-_---_---..____----._._-_------_-.------_.--_.-._...----------_-_-..-.---.-_-.------.-.. ------------------------------------ ........... --.i .. -_..__.._- --------------------------------------------------------------------------------------------------------------------------------„----------------.-----_.___._____--__-___-__---------_.--.__-____-----___-----.__-__-_--_._.- - --- � - r FINAL INSPECTION BY:-':------- ==� Date f - --------------------------------------------- I 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 i5-9-2M ~`~: Revised W-2100