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APPLICATION FOR SANITATION PERMIT Permit No. _24-S2-- . (Complete in Duplicate) Date Issued ____J-fP_ 4---__ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. e in nance - -- --�---- ------------ - No. 549. This application RESS IAN ;�*OCATION complianceCounty -----" ----------------------------------•-----••----- •-------------------------------- JOB ADD Owner's Name------01_t_1*_27_ - •----------------- ------------------------------------- Phone....-------------------------------- Address...... ----------------------------- -Address---•-- ---••-------------------------------- •.....-------------------------------------.....---...._...........-----.--------------------------- Contractor's Nam• I�^ ---------------------•-----------------------•-•----------------- Phone��._ '' __!_-(, i Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ T Number of living units: I__ Number of bedrooms -4__ Number of baths I--- Lot size .X ___________________ Water Supply: Public system 4--community system ❑ Private ❑ Depth to Water Table J.'___ ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No P4---Pew Construction: Yes ❑ No E��. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi4A4,, Tank- Distance from nearest well-----------------Distance from foundation__-_____-..____--_.Material------------------------------------------------- No. of compartments---------- -----------....Size--------------..-------------__Liquid de th-----------.__-.---------Capacity sposal Field: Distance from nearest wellefto%o4.w—Distance from foundation___-_��__�____.Distance to nearest lot line_____-_-__- �— Number of lines-- -/-_--_-_.�_ _ --------Length of each line___��__-_......�__._.Width of trench.....•QA/-� ________________ Type of filter material._.- _-. -__ Depth of filter materiaL.__f ________.Total length___-___ __________________________ Seepage Pit: Distance to nearest well._*eA.Q0*%A----Distance from f undation___A19_!____..Distance to nearest lot line_--T-•----- Number of pits._.___________----_Lining material__-...Size: Diameter-_-71#1---------Depth------ .( _._____________-___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------._--.----------------------- --�� ❑ Size: Diameter------------------ -------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. �0 _._Distance from nearest building _________________ Privy: Distance from nearest well -- ------------------------ --------- g----:--------:---------- � ❑ --. Distance to nearest lot kine-------- ---------------- ----------------- - ----------------------------------------------------------- - --=-- --------- � PJ 9 �Remodeling and/or repairingdescribe}--------------------------------------- --------------------------------------•------------------.-------------------------------------------------------- ---------•---------------•--------------------•-••----------•----=-----------•-----------------------------------------------------•-----------------------------------------------•---------------------------------•- -------------------------------------------•----------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- 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 Health District. L . (Signed)-- ----------- ------ ---------- --- -------------------------------------------- ----------- ----(CVffI1?`3`RVftrr Contractor) By:... -- -:- -- --------- - -------------------------•-•----------- ------(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 APPLICATION ACCEPTED BY----------------_---- - —- --%---------------------- DATE w REVIEWEDBY------------------------------------- --------------- ------ ----- -----------------•------------------------ DATE--- -----. ._ _�' BUILDING PERMIT ISSUED-----=-------- " - _ DATE-------------------- �y-----.--••-------•------------ and/or recommendations:-. '. - ----------------------------------•---------------------------------------------- --------------------------- Alterations - ------------------------------ / - .. -� --- ---------= - -�- sl-._e _.- i'_.�_� G:._-- --4.'. ,,.-. --•--------- �-------------- �` FINAL INSPECTION BY:.-_ _ -------------------------------- Date--- 1-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cellfornia Lodi, California Manteca, California'. Tracy, California ES-9-2M 145446 PTW" 12.541. �. f