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APPLICATION FOR SANITATION PERMIT Permit No. __161/ (Complete in Duplicatel _ Date Issued -- �3 S Applica4ion is hereby made'to"the San Joaquin Local Health District for a permit to construct and install the work herein described. 5 This application is made in compliance with County Ordinance No, 549, JOB ADDRESS A LOCAT i Owner's Name_ ... Ph ------------------------------------------ one - Add ress...-------•--•-----•--= - ----- Contractor's Name. 'L 4 Phon tl .� tee ' --------------- Installation will serve: ResidenceApartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.1 _- Number of bedrooms N--Number of baths ---/--- Lot size ---- Water Supply: Public;systerri El '-Community system [] Private 9!1_-Brpth to Water Table�'�' ft.- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Gay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No Z5---lq—ew Construction: YesC.�•-��o u TYPE OF INSTALLATION, AND,SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Se'ptiQ Tank: Distance from nearest well--- _Distance from foundation_--_-1 -~e rMafeFial2----------------------------- No. of compartments---._-._.-z- ------_Size__r��----X_� ---Li Liquid de th_-.-_ i / q p ---k- -------:CapacitY.--- i -�------ Dispo al Field: Distance from nearest well---b_d.-',--°Distance from foundation.---_-1�.�--_-Distance to nearest lot line--- -�---. Number of lines-__--'_` --f/_ -: Lengfh of each line...... -°-----Width of trench-.-_ ` ---------------------- t _Type of filter material-_-- - -L.,_-_e-/Depth of filter material--_-_� -__---. -length---.---�----__-------- Seep ge Pit: Disfabe.a{p is rest.well_-- __--_---------bistance from foundation_--.. �. - `-� �o - - _....--.__.Distance to nearest lot line---.� j Linin material_-- -r Size: Diameter-7-F --_---__De tn_- 1 ` ' ❑ Size: Diameter--- `--------- Depth - _ Lining material ----- esspool: Distance from nearest well-----------------Distance from foundation---,-.------ Privy:' Distance from nearest.well------------------------------ t Distance from nearest building ❑ Distance to nearest lot line--------_----- �.. s -= y y. r - ---------------- Q Remodeling and/or:repairing (describe)--------------------- ------------------------------------•------- -------------•-,-------------------------------•-------- -----------•--------------------------------------------------------------------- ----- ; - -------------------- ---------------------------------------------------------------------- --------------------------------------------------------------- - -------------------------------•---------•-------•-- t' - ---•------------------------•------ -•-----•-------•-•-•---------••----•---- - `-------------------------------•-------------------•-------------------- V I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin-County t�1 ordinances, S alaws,pnd rule d regui tions of the S n Joaquin Local Health D' reit. (Signed)------ `-r---- ---•- ontract` C orey:..... --- "---- -----------•-..-(Titls]----------------- -.-sy-vl �' (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 �t -------------------------------- REVIEWED BY------ -- t DATE------------- BUILDING PERMIT ISSUED-------------- .. --- -- -Z-------7--1----------------------------------------------------------------------------------------------------I----------_-----------,---D--A----T-- - BATE --- Alterations and/or recommendations:-_---------- ---- -•-----•---------••-----------••---------------------------------•------=-- ----- - ,�{ 46 FINAL INSPECTION -- - Date.- ,- -�` �.�� 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 E5-9-2M : Revised W-2100