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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) m/ • Date Issued ----- \�lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. TT application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT O _ _' � 0 -------•------------------------------- --------------------------------------------------- ! Owner's Name__ $ � 'ar°'e ,t ------ Phone --------- ----------------------------------------------- Address---_-------------- •-•- Contractor's Name-- '1--- � ----��- ---------------------------- Phone----•------------------------------ �� w _.rrtr -.r�+i Installation will serve- tResidi nce 'Aparfinenf'House ❑Commercial ❑ Trailer Court ❑ Motel ❑ O&ZA.1AA4W) er ❑ rr r F Number of living units: _;4mmun�ify mber of bedrooms __ (f baths __!-___ Lot size 0V__X s stem Priate ber De th to Water Table ________ ft. Water Supply: Public system y ❑ ❑ p Character of soil to a`depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo�PN m Clay Loam E] Clay E] Adobe�rdpan ❑. 1 Previous Application Made: Yes El No � New Construction: Yeso ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q 7- (No septic tank or'cesspool permitted if ublic sewer is available within 200 feet) � r _ Septic ank: Distance from'nearest.wel -��&____�`Distan e ffrorZQ.7f un ation��____________.Materia_�_cr_____::�_____________�____..________- Sixe • -Li uid de th- ----- Afrf-------Capacity ,� ------- No.. of compartments r q P p �Y t Dispos�l Field: Distance from nearest w II__ _ Distance from foundationc►,.�,.6! _ .._____'.Distance to nearest lob lin�__; --�! "'' C. Nuimber of. lines__________ Length of each line_____,_�,e_ ?� Width. of trench______..__ ____ --------------- Type --- -------- Type of filter materi Depth of filter material._____ T-------Total length______________ ? Q See ge Pit: Distance to nearest well__ _ [)J---, istance ro ifEund icn�_dP__5_______-Distance to nearest lot lie_______ E . Number of pits-)------------------Lining material _ e: Diameter-----3-----------.Depth_-2.©--------_----�_--��yj *.Cesspool: Di�tance-from-neare-st'well _•Distancesfro ionli.),-_-___.__..Lining material-_-_____-______.___________________ Size: Diameter----- ---- ------------ Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. \' Privy: Distance from nearest well------_------------------------------------------Distanc6 from nearest building------------------------------------------ C ❑ Distance to nearest lot line------------------------------- ------------- ----- Remodeling and/or repairing (describe):----�,,�--ff Aelt-4-'L - -- - -----•��--`--• � ----------------------------- r y -- ____________________ 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 HeAW District. " ___Owner and/or Contractor (Title)------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY -------------------- DATE APPLICATION ACCEPTED B)Q--•--------------- ---------------------------------------------- REVIEWED BY-----------------------------2` - --------------------- I -------- DATE-- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- ,------- DATE------ -------------------------------------------- Alterations and/or recommendations------------------------------------------------ -------------- ---------------------------------------- - ---------------------------------------------------- ------------------------------•------- ------------•------------------------------------------------------------------------------------------------•------------------ ---------•------------------------------------------ ----------------------------------------------------------------------------------------------------------------------- --------------------------------------------•-------•----------------•------...---------------------- ----------------------•--------------------------------•--------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------- ---------•-------------------•----•-------------------------------------- --•------------------------------------------------------------------- ------------------------------------------------------------------•-------- FINAL INSPECTION BY:._/� --- --- - -------- Date ' r S N 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 Revised 1,57 VP CO.