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APPLICATION FOR SANITATION PERMIT Permit No. ------ Com lete in Duplicate)�- `3 u (Complete P� Date Issued -__---f,11� �� Applica=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 AND LOCATION-S"' " t d�� i ' ✓ �1 Owner's Name---------I�/E ``-------- ---------------- ------ -------------- --------------- --- --- - Phone--------- Address------------ -- -- - -Address____________ ____ c- &e, -- --------------------------------------------------- ---------------------- -------------- ---------------------- Contractor's Name________________ ------- / —------------` - -- -- ---- -- -- - -------------- ---------- - ---------- Phone------------- --------------------- Installation will serve: Residence Vl-'Apartment Howse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J._ Number of bedrooms -IR--- Number of baths __/_- Lot size _�y✓�_ X4�---------------------- - Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 25---Rardpan ❑ Previous Application Made: Yes ❑ No E' New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t ti4 Tar Dot n co r art ea tsr well-----------------Distance from foundation.___-------..Material------------------------------------- p � �c� p - -- ----- -- Size-------------------------------Liquid depth------------- - --------Capacity-------------- is 1 Field: Distance from nearest wO._lk,0''�`` ` - P� Distance from founc#ation_-.=�.�--------.Distance to nearest I� line___47 ________ ��` '�f , � Number of lines l Length of each line Width of trench �. 1 s �' ► ' Type o1 filter material./" Depth of filter material.-.--�_F� � _-_.Total length _ � p g -- page Pit• Distance to nearest well j La: ' 'Distance from oun ation_.� ..____._.Di%fance to nearest lot line P g �� Number of its-----�--------------Linin matenal,��'- .--.';� " Cesspool: Distance from nearest well------ ❑ Size: Diameter ------- ---Distance from foundation__ ------------ -Lining material ---------- - ................. \1 -------... -Depth-------- - -- --------------- ------Liquid Capacity-------------- ---- gals. Privy: Distance from nearest well----- --------------- - from nearest building ❑ Distance to nearest lot iine---.-_- Remodelin and/or repairing describe :----- /�- = �`s f-------- � Y r �� !` �-C'• -----=------------------• - ------------------------------------------------------------------------------•----------------- ------------------------ - ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify tha+ 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. (Signed)------------------- --------- ---------- ----- Contractor) By: == = --------- - ---------------(Title).------, �_ .� _ ` (Plot plan, showing size of lot, location o ys+em in relation to wells, buildings, etc., can be placed on revers side). ---------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -.- - .- _ ------- DATE---- --.: - REViEWED BY --- �.,. ING AltarDat ons and or7recommDendations.. '------------------------------------------------------------------ DATE---------- ,. A : =+ �"----------- ------------------------------------------------------ -----.`. ----------------------- ---- - - -------- - -------- -- -------- --- ------- ------- --------- --------- ---- ----- ------------- _T1 e:.- ---------------- FINAL fNSPECTION BY:_..- �S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 LM 145446 nr WOO❑ 12-S.