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APPLICATION FOR SANITATION PERMIT Permit No. __7_�__7", , .. {Complete in Duplicate} Q� Date Issued Application 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. 542. JOB ADDRESS AND OCATION____ _ _ _ ----------------------------------------------------- Owner's Name _ G _rN----- ----------- -- ------ ----- - -- ---------------------- Phone---------------------------------- Address----------------------r-11--91ve'----------------------------------------------------------------- ------------------------------------------------------------------------------------------------- Contractor's Namef"KA0/_ _ •- ��c-'---------------------------- ----------=-----=-- ------ Phone----------------------------------- Installation will serve: Residence ®'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __:7__ Number of bedrooms ---7Zn--Number of baths ___/__ Lot size _7 ___-______________.- Water Supply: Public system Community system ❑ ' Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes [❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- y Distance from nearest well________________u Distance from foundation--------------------MateriaL___._______.__._.__._________.______--_______-- ❑�J�(S'I'w/ No. of compartments--------------------------Size---------------------------------Liyu�id th-------------------------Capacity---------- -------- sal Field Distance from nearest well-,wOME' Distance from foundation__- _ -._.-_.Distance to nearest lot line...,�b__f_- lid wvAa umber of lines______________/ _._ Length of each line----------- p__-.__.__._.Width of trench..._ r L {--------- Type oT filter material __..S_—Depth of filter material___.__/_B.._-_-__.Total length---------------------------------------- Seepage _____________�G__�_._._..__.._. Seepage Pit: Distance to nearest welt---------------- ----Distance from foundation------------------- Distance to nearest lot-line----------------- El Number of pits----------------------Lining material--.---------------------Size: Diameter-----------------------Depth----------------_- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material _.___.______.____._______._______.-. ❑ Size: Diameter--------------------------------------Depth------ --------------------------- " - ------Liquid Capacity----------------------------gals. (, Privy: Distance from nearest well-------------------------_--------------------___Distance from nearest building.____._._____.____-__-._______-._-__-.-_.. v ❑ Distance to nearest lot line--------- --------------------- ------------- --------------•----•--•----------------- -----------------------------------------•----------- 5G ----------1 :� --•---� '----- Remodeling and/or repairing {descrik�e):___,,..�_� -- � __� __� � .._ _ . � __��' .._ (2... ----------------- .,...... --- . f '---- --------•-------• --------------- -----e MI------�--------:...- _ �� --------------------------------- 1 1&k��•�-�r-----�---t�.-"- (1'C' ��'^ki�-l�.��L �a�.�C.�... � _..-�., ��.. r��-----'e�� _��•,�. j - --- - - . = fir! f .. � ... I hereby certify that I havelprepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statg1l and rules and regulations-of a San Joaquin Local Health District. R (Signed) f1_ _�A SAI-------�- -----�------ ---------------------------------------- { ner and/or Contractor} BY: -- - -------------------- - [Title) (Plot plan, sho2�f size olo+, location of system in relation to wells, buildings, etc.;can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- _: = DATE REVIEWED BY �" DATE ----------- - --. BUILDINGPERMIT ISSUED---------------------------------- ----------------------------------------------------------------- DATE-------------0----------- --------- ---------------------- Alterationsand/or recommendations:----------- ------------------------------------------------- --------------------•---------------.......----------------------------------------- ------------------------------------------- -------------------------- --------- --------- --•---------------- ----------------------------------------------- = ------------------------•--------- ----------------------------------------------...--------------------------------•--•-•---------- ----------------------•--------------------------------•--------------------f. ----------------------- --•-------------- ---------- ------------------- -------- FINAL INSPECTION 6Y = ....... 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 'E5-9 149446 arw000