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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) r r Date Issued __7/ 2 59- �E Applica{ion is.hereby made to the San Joaquin Local Health'Districf for a permit to construct and install the work herein described. This application.-is_made-rinrcompliance with County Ordinance No. 549- D LOC TIONA s JOB ADDRESS ANDW Owners Name---•----' '--�=- � �---•- --�-•- ---- � � -- Owner --- ------ Phone------- Address-----�---�`a---• ---------h4k ; - ' T Contractor's Name_- -,--- _ , � --�,�o �1 �y+� •- �' 'F- ---------------------------------- J 1'6�sG - Phone ---------- Installation - ❑ Other ❑ .� Installation will serve: Residence ''VApartment House ❑, Commercial ❑ Trailer Court 4 Number of living units: _L----- Number of bedrooms _ & ❑ Motet , Number of baths ---__- Lot size Water Supply: ,Public.s stem'~ = ----------- pPY• F y ❑Communityystem ❑ I}rivate epth to Water Table -------- ft. Character of soil to a depth of 3 feet:' Sand,[] Gravel ❑ Sandy Loam�No Cc, lay Loam ❑ Clay Previous Application Made: Yes E'No d New Construction: Yes ❑ ❑ Adobe ❑ Hardpan ❑ TYPE OF INSTAf=LATIOWAND SPECIFICATIONS: (No septic tank or cesspool per if public sewer is.available within 200 fees.) Septic Tank: r Distance from neares+ welt - p-Distance from�fou dation-(-i/- s f�fo. of com artments_--------_ ------ Mafia i�# p • Size- ! _ --._-?C F Liquid epth Capacity__�___ " - --------- Dispos .I Field: Distance from nearest weIL59_�x p y % istance from foundatio f Distance to nearest lot li t Number of lines-------- -- - 1______________Len th of each lineb F- Type of filter materia^} + g Width of trench-----_ �f--------------- Seepage - -- -----------Depth of filter materialN------!�---------Tofal length------- - - --_ See a e Pit: . • --------- ❑p 9 Distance to nearest well-.__-.--i___:_:-_-___Distance from foundation-------------------Distance to nearest lot line----------------• f Number of pits`----------------------Lining material---------------- ------Size: Diameter--------------- ' Cesspool: M -.,rDistancefrom"-nearest wells%----------__Distance from foundation--_-__-_--- - ,.5 Lining material------------------------------------ ❑ Size::Diameter: ------ ------Depth------------------ r. -- --------------Liquid. Capacity---------- --- ------- -----gals. r - w Privy: Distance from nearest well,.! __.-- _---- ------------ --Distance from nearest building 9 --------------- ---Distance to nearest lot line-_ __..____-__-.-' .. y ........,..�. ------ --------- ----------------------------------------------- Remod in t-. . I ,,ry �.�... . _ I g 9nd/or repafrin ' (d scribe):_ y� y� vv -- ----•-------•--•-- -----------------• ---•--------- -------•----------------------•-------------------------•-----••------------------------------------ ------------- 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,tand rules and,regulations o the San Joaquin Local Health District. [Signed} / f - - ---------' - - • ,I ------=------•---- -------- ----.-----(Owner and/or ;By:------ -- -----= -/`------------------------[ .� ac tor) - tor) By: 4 d/o Contr (Piot 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`-3 ------------------------------ REVIEWED BY------ - -- - - -- ----------------- --------- -------------- ------ DATE-�5-------------------- BUILDING PERMIT ISSUED---------- -- ------ ------- -------------------------------------•---------------- ----------- ------------- DATE----- Alterations and/or..recommendations:--- -----•------------- yi ------------------------- ----------- eN ------------------------------------ FINAL INSPECTION BY:-------- -- - I- - ------------- �. ------- •--- = Date-- •' __ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, CeliForrtia Manteca, California Tracy, California E5`9 745449 ATWQCD