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I0� APPLICATION FOR SANITATION PERMIT Permit No. .___fR..� . z (Complete in Duplicate) Date Issued _-_ - .� YA-plica+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. 549. JOB ADDRESS D LOCATION---- ...-----• c ''°`.'r ---------- ---------------•------------ Owner's Name---- ---------------•--•--- --. � -=- } �a4..fi � Qt. �- --- ---- Phone --fP ,3�. Address.....------------1-• l M-. :4 -- - - -- --- -------- -•-------------------.....-•-------------------•-••--------------------------------------------._.. Contractor's Name 1? _.--1 - Phone #1 f6-�- . Installation will serve: Residence G--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-_-- Number of bedrooms ,S-. Number of baths J-__ Lot size ---c5_74>- _-.1�" - --------------- Water Supply: Public system �ommunify system ❑ Private ❑ Depth to Water Table ft. ' Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam [I Clay Loam El Clay El Adobe a hardpan E)Previous Application Made: Yes ❑ No New Construction: Yes �lo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Q-�---•-_.Mater'al-c_��------ [ Septic T}nk: Distance from nearest w�•ey1111fl1'�___Distance ��m foundation__ -_ � ----------r--� No. of compartments-...Z...--- ------Size---- ------Liquid depth_��_- Capacity___;© . � g �i Disposal Field: Distance from nearest weilWone---Dista tr foundation-----1-.7........Distance to nearest lot line-.___��'? Length of each line__ _..'___.,__.----Width of trench.,�.r�'............... ..... Number of lines__:_ ---------- �� 1 Type or filter material__._ ---Depth of filter material---Z-8..........Total length---.--- - ---------------------- Seepage Pit: Distance to nearest well [a>e7E---- Distance from foundation---4. _`..Distance to nearest lot line--- --------- -------------------- Number -—--. W i j i g ' �3/Lta-C ..Size: Diamefer �� ----De f'n---F7 ❑I Dumber of prts Linin material '"'f P d0-------------------- Cesspool: Distance from nearest well---- -----------Distance from foundation--------------------Lining material--------------------------------------- ❑ Size: Diameter-------- ------------------Depth--------------------------------- -----------------Liquid Capacity---------_-----------------gals. ti. w `, , �. . Privy: Distance from"nearest well___- ___--- ------------------------- -Distance'from�nearest building::-----.-----------_------------------- 4 �., _ .. ❑ Distance to nearest lot-line-------- -------------- ------- -----------------------------=-----------_-------------- Lq _. Remodeling and/or repairing [describeJ:__ _� /�- =`---• • ---- ��' `�` A`' "`---------------- 4 ___ i ------_• ------------------------------------------------------------------ ---------------.--------_-------.------------------------------ r --------------------------------------------------------------------------------- I here certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , St a laws, and rules and regula ' ns of the San Joaquin Local Health District. J( Signed) - ----=----- ----------- -- - tf Contractor) I ) a�C�rr -------------- By:.---•--. ------------------------------------------------------------------------- -------- --- ------Title ----Ped:Con _ (Plot plan, showing size of lot, location of system in relatio to wells, buildings, c., can be pla reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY_ -.------ -- DATE_�------------------------------------------------------- REVIEWED BY ------------------------------------ - ------ DATE--- -----------------------------------•------•------- BUILDING PERMIT ISSUED----------- -------------------•-•-- --------------- --- ----- DATE-.---" t ------------------------------------------------ Alterations and/ort recommendations.---=T .f------- - --------------- - ------•---------------------`-----------------•----------- �-------------•-------------- �f - f -------------------- ------------ ---------- •------ -- - r ►.rf �- ------a+r .r '� 'a . Fes+'-• '- ---------- ------------------------ V xp ----------------- ---------------------------------•-------•------•------------•--------I/------------- ----------------------- Date--------- -••`--------•-------•--------------------•----------- FINAL INSPECTION BY--------------- ------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145.446 nTwoon 12-54