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APPLICATION FOR SANITATION PERMIT Permit No. ...Q...S_ (Complete in Duplicate) i Date Issued .:�/7-f-_)__ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544. �� <! ` JOB ADDRESS-AND LO ION..I5"r1�5C",.---/Vp1e�--0 --Gs_E___�I,N '__Qj'"S/f� ---Q F;V-, Owner's Name `._.. 'r Rep------------ � --- �y ---•------------------- Address----------------------------------- ----�.l,Z.- Mc � __.-S ' : Contractor's Name-- ---•-- -- �>S - � tO _� -------------------------------•---••----------------------- Phone � - .a6l.1 Installation will serve: Residence Apartment House Commercial Trailer Court P ❑ ❑ ❑ Motel ❑ Other ❑ Number of living units: ___t--_ Number of bedrooms 1'Number of baths I----- Lot size S------_____________________ ______ _ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table -�O ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe„4 Hardpan ❑ Previous Application Made: Yes ] No 5Q New Constru'ction: Yes ❑ No ❑ ll®U5E" /1/1,pV8W /,A1 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___/V,0NE__Distance from foundation..... - - _ Mater•i�al___- No. of com artments_- - Liquid depth-_�.�Z -------------C�►.a4-p�a'c.if y_g,.Q Disposalfoundation- field: Numbee ofolines�arest we€1- /PN -Dis atnc e 1from foundation_ :b--�•_..__--_.Distance to nearest lot line____s_-____ �} ----- tr .-. .------- 9 o#each line-.,.�Q ---- -----------Width of trench---•��--�----- --- ---------- � y, M Type of filter material+_- � .-Depth of filter material____ _ �..._A___.-Total length_-_. �.--__________________________ p g 't°'a' Distance to nearest wefl_.IYVA ...__Distance �fro,m�•fo dation____ Distance to nearest lot line__ _______ �•,, ;. Number of pits--47.).4 material___-+;�1 a. J---_-___ � "- .` ee a e p ----- 9 - - - S¢e: Diameter-- ---Depth -- ---- -- ---:- ------ Cesspool 1, Distance from nearest well-----------------Distance from foundation ---- -------- _.___.Lining material__.___________.__ < ❑ �`± Size: Diameter----------------- -------------------Depth----------- ---------------.-----.----------------Liquid Capacity- -------------------------gals. Privy: ' ? Distance from nearest well--------------------------------.................Distance from nearest building _ -------- ❑ "` `` Distance to nearest lot line_________________________________ Ni ---------------------------------------------•------------------------------------- ; 00, Remodeling and/or repairing (describe}:_-_ ---- --------------- ------ - = ---._... ------ ------ ------ ---- - ordinancesbS---------------------------------------------------------------------- - -• -----------------•--------------------------- -------I-------•------------------------------••------------------------ certify that ve prepared this application and that the work will be done in accordance with San Joaquin County State laws.land ales and reg ations of the San Joaquin 'Local Health District. pF (Signed) _. ---- ------------ --------------------------- (Owner and/or Contractor) By:------------ ------------- ---- ---------- - - ---------------(Title)- ----- (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placetr on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- - - -------------- ------------------------------------------- DATE-- REVIEWED BY= -------------- DATE--- - - BUILDING PERMIT ISSUED-------------- ---------------------- -- - DATE------------------ Alterations and/or recommendations ------ - -- ---------------------------------------------•---- --------------------------------------• - - - - -------------- - ----------------- ---- ----- ----------------- ------------------ ~'= .� � -- - ------------------------------------------------------------------------------------- -------------------------------------- ---------------- -------------- •----------------- - '--------------------------------------------------..----------------------------------------------------------- -------------------------------------- -------------------------------------------------• ----------------------------- FINAL INSPECTION BY: "-------------=------- Date------- ---.1 . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES=9 145446 ATWDCD