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qjv ,ry APPLICATION FOR SANITATION PERMIT Permit No. ........... (Complete in Duplicate) Date Issued Applica{ion is here6y 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 CATION__7;3LyyLk6/�------ -- / E�- ..-��xiuky1 -t.__l , : Phone* T� j' rOwner's Name ------ � la Address---------------------all 4YI-'J-e----------------------------------------------------------------------------•--••-----•------------- Contractor's Name:---`------- �ae-&-h/7---- -------2: --- --------------------------------• Phon�Q_----�/-�Q Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._1__ Number of bedrooms _Z__ Number of baths Lot size ---_____________ Water Supply: Public system ❑ Community,system ❑ Private Depth to Water Table S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'E] Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No R,-_"`New Construction:' Yes R---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) L Septic T k: Distance from nearest well__�e__---__Distance from fou ndation_fQ__-____._.Material_v�C-��!�-C�R�________. No. of compartments_ 2-----------------Size- --- �� Liquid depth------x1.77- -----Capacity._%.Q0-------.-- Disposal field: Distance from nearest well_.Q____Distance t om foundation____ ---------Distance to nearest lot line.....�i...`.. Number of lines____. . Len th of each line___ Width of trench___ �f ---- g -'f? �� ------- Type of filter material.__� S,.__- -__Depth of filter material_____ _ _________Total length___-� Q---___________________- ) i Seepage Pit: Distance to nearest well_.f_QA0_.....Distant rom foundation__ _._.. istance to nearest lot line------�t C v Number of pits----/r- --------------Lining material_ _ ___._.Size: Diameter__. . .!!___Depth----ZJ-7----__ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material----------------------.--_____________- ❑ Size: Diameter---# '------------------- - -------Depth--------------- ------------ -----------_--_-Liquid Capacity----------------------------gals. �- Privy: Distance from nearest well------------------ ---f- ----------- ---------- .--Distance from'nearest building-------------------------------------- ❑ Distance to nearest lot line------------------I..............: Remodeling and/or repairing';(describe)---------------------k-------------- -----'---- ------------------------•-----•------------------•-------------•-------•----------••------------ 9. ---------------- I h eby cert�Ia:ws�, and at I have prepared applicatio nd that the work will be done in accordance with San Joaquin County ordinance fate r and re ns of the n Jaaquin.Loc 1 Health District. F ontractor) (Signed) d ------- - ---- ------------{Title. - -- ------ --- ------_-----------_- _ (Plot plan, showing size of lot, location of system in re on to wells, buildi , etc., can be pi ed on reverse side). O w 4 I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ DATE ;,- - REVIEWEDBY------------------------- ------------------------------ -------------------------------------- DATE---_ -----•-----------------------------•------------ BUILDING PERMIT ISSUED---=---------�---- -- ------ DATE..-------�`�-------------------------------------- -- --------------------------------------------------------------- ------- Alterationsand/or recommend a+ions--------------- -------------------------- --- -----------•------------------------------------------•••-- -N,-----------.......................... --------------------- ---------•-------------------=------------------ --------------------------------------------------------------•---------------------------•----•-----------•-••-----------_--------•---•-.----•-------- -----•------------------------------ ------------------------------------------------------- ----------------- -------------------------------------------------------------------------------------------------•-----•----. ---------------------------------------------------- ----------------------------- ----------------------------------------------------------------- ------------------------•----------- i C ----------------------------------- FINAL INSPECTION BY:. 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 145446 ATWODD 12.54