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��- ,Q.• APPLICATION FOR SANITATION PERMIT Permit No. v' (Complete in Duplicate) / Date Issued �7 Application is hereby made to the San Joaquin Local Health District for �9I 4to_� / 9 permit to con ru aq�insf ISI the work herein described. This application.fis•,.made in compliancezwith County Ordinance No. 549. � I t fl�•r c� [A-�t--A/,I- yam, JOB ADDRESS AND LOCATION_ '. _ _. ---------. Phone-- .F Address Owner's Name------ - --------------------------- ----------------------- ------ Phone��-±------------------------•----------------------------------- ---------------- ! Contractor's Name------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms,. __ Number of baths 1�--- Lot size ...... Water Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �/�ft. Character of soil to a depth of 3 feet: Sand 'Gravel f andy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No R9` New Construction: Yes ]o ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200-feet.) r -septic Tank:= = Distance from nearest w ll Distance-from foundation._?//' . - p I +e - _ ---------------------- 0. + y :.Size_t t1""A_-__1,e --._Liquid depth----- " [ Nof compartments-_ f,__...----__._Capacity___£F� Disposal Field: Distance from nearest well.well. .. Distance from founda+f4__ ---------Distance to nearest lot line__. Number of lines------xr_ --------------------e---Length of each line--- .- ._(..-.�----...Width of trench----- `'-------- --------- .. Type of filter material =_ ........ _-Total of filter m,fenaL..-�a "_._Total length------l�v--------------- Seepage ___. _ w � Seepage Pit: Distance to nearest well--s- � f�Distance �'o�r ation___c2_,�_�__ .____.Distance to nearest lot line-- Cesspool: L p g '-'`-.Size: Diameter__..1?_1�-�---------Depth.... Number of its."__f___.__'__. �__Linin mater:aL Distance from nearest well________________=Distance from foundation-_.--.....__;_--_-.Lining material--_.__._.____..._____ ❑ Size: Diameter----- -- ------- Depth- --------------------------- ----- ------Liquid Capacity gals. ------ Privy: Distance from nearest well---------"..__._._.....-------.-----_----------__Distance from nearest building__..._-____.___--_____--" _� /k t. ❑ Distance to nearest lot line_..__--..--:_____--__""__-___,__-. -------------- ---------------- -------------------------------- a. Remodelingand/or re airin descr'be):,________ / p g [r/��g��jl/y j///fJ/j +�' Cf GAY' _ /� _ _ ___.—� y _. •--- ------ --___ - �•.f' ---•--•------------------ ----------------- ------------------------ ----------------------•---------- -------•------------------------------- ----- -------•-----------------------------•-------------------•--------------••-------------------------------- 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 re ulaj" 11,San Joaquin Local Health District. {Si ned _.._l g }-------------•.-- -- "-• - -- _-- - _{Owner and/or Contractor] BY- -------•----------- '- -- ` Title---- (Plot-plan.-showing size of-lot, !oc ion of system in relation to wells, buildings; etc., can be placed on reversrde). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ .________ DATE-." ----------------------------------------------------- REVIEWED _-____________-_--._ -" REVIEWED BY ----------- 0DATE - � :. ---- ----- - - ------------••-•------- BUILDING PERMIT ISSUED---------- ------- - ------------------------------------------ ----------------------------- DATE------ -..R -------------- Aterations and/or recommendations------------------- ---------•--------- - ---------------------------- ---------------- ---- FINAL INSPECTION BY--- --------- - ------------------- -- -------------------- Date-- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americ'en Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California e5---9 4145446 ATWtlbb