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' Permit No. _..a --. --------- APPLICATION FOR SANITATION PERMIT J` I (Complete in Duplicate) ate Issued Alp ication is 'ereby made to the San Joaquin Local Health District for a permit t onstruct and}install the work herein described. This applicatiok is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_.. `�-- --------- " "" _. on ----------------------- hh -- - Owner's Name 1-------------------------'` S -------�-- -- ----------- -•- � 1 Address---------- ------ ---------------- ----• -----•-- -- - Contractor's Aamet-- --------------------- ----------------------- I ----- Ph Phone Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,,qq //D ,>C 1 Ott-o----- -------------------- Numbep of living units: __-.____ Number of bedrooms..s.�__.,Nymber of baths .-Z Lot size _ _-""'_____""__._""____ Water Supply Public system ❑ Community system ❑ Private Depth to Water Table.-"..__. ft. Character of s ii to a depth off 3 feet Sand ❑ G/r4LI ❑ 5alndy. Loam Clay Loam'] Clay ❑ Adobe ❑ Hardpan ❑ Previous Appl�Ipcatian� ade:' Yesy❑ to �. NeG Const:ructionl: Yesk - 1 No ❑ k� TYPE OF INSTALLATION AND SPECIFICATIONS: . ,..-� (No septic tank or cesspool perrnitted if public sewer arable wi#hin 200 feet.)r : ��, { Septic Tank: Distance from neaest well__ Distance from foundation----/" ----------Mate�ialr___ - '' �-!------- " No. of compartmenhs---------2-.- Size----�3- -9 - ------Liquid depth---- ' - - ------ -Capacity------ld-- --- Disposal Field. Distance.f�omneare�tvl--. ""�i-DistarCe from foundation___-�r ----Distance to nearest lot line_____'___.. ---�. Width of trench-------------2-4 � t . : '54, Number of iines�'._�_=_��'�""""�""�"�e�9�hrbf�each line___.__,,, ��,---- E r Y Type or filter material_ Depth of filter material "____")g_"_____Total length_}_._- __2_______"_____* Seepage Pit:' Distance to nearest well_-'�---_-"�;Q.'s_stance from foundation-___.-__ ___-_______.Distance to nearest lot line_________________ i ------Linin material------------ -------- 77r!V Siik'Diameter-----------------------Depth----- --------------------------- ❑ Number of pits_---------"-" -- g .� � I � 1 Cesspool: Distance from nearest well-----------------Distance from.foundation._.__"______ Lining materia-------------------------------_-____ 5iz a: Diameter------ ------------------------------Depth----------------------------- ------ --------Liquid CapacitY-------------- ga ❑ Distan e from nearest buildin ------------------------ Privy: Distance from nearest yell______________ _______ ❑ ----------------------------------------------------- Distance #o nearest lot line-------------------------------- ------- :._ `v Remodeling and/or repairing (describe)------------------------------------------ ------------ ----------------------- i "-•-----------------------•--------- ----------- --- ------------1-------------------------------------------------------- �p = "k __�{'.�_-----...---j----------------------------------- --------------- ------------------)-----------------------.-------- - - ---�`---------------------- I �--------------- ------------------ �I� ---------------------------------------------------------------------------------------� 1-------- -------------------------------•------------------------------- I hereby certify that l have prepared this application and that thekork-will-be-done in 'accordance with'San Joaquin County ordinances, S#ate laws, a le d regulations of the San Joaquin Local Health Disfric#. a ---------- ___-(Owner and/or Contractor) (Signed) ---------------- By:--- ----- ---- ----- 'Id - -------------- ------------------------(Title) " (Plot plan, sowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse------------------------ ide). FOR DEPARTMENT USE ONLY f DATE -7,---� 4-- ------------------------- ----------- APPLICATI �i N ACCEPTED BY--.--------------- ---- --- -- -- - REVIEWED�BY - --- ----------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------- ---------------------------------------------------------- DATE--------------------------=------------------------- ----- -- i �pnd/or recommendations:"---------------------------- ------------- --------------=-::-.•-�:----"=-------------------------------------------- Alterations . ----------- ---------------------------- ---------------------------------- --------------------------- ---------------------------------------------- ------------------------- ------------------------------------ --------------------- --------------------- ------------------------------- Date_----------- ---------------------------•---- FINAL INSPECTION BY----------------" SAN JOAQUIN LOCAL HEALTH DISTRICT � t 130 Sou h American Street 300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California 1=5-4-2M 10-52 Revised W-2100