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i APPLICATION FOR SANITATION PERMIT Permit No. -----2_71 r (Complete in Duplicate) Date Issued 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_._ /g-_..___55-_>�-___-_- Owner's Name _f I L>PZ---------- l�j Pic._ � y e Z_ . ----------------------------- Phone Address--------------5' -----•-----------------------------------•-------------------•--------------------------------------- e - ------- --•------- -------- Contractor's Name------ �__5p- - LSnC Phone._-... ------•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ] Other ❑ Number of living units: _,___'Number of bedrooms •---2—. Number of baths --- J. Lot size ---7�3•____.�- r Water Supply: Public system Community system El Private [:1 Depth to Water Table -_____ ft: Character of soil to a depth of 3 feet: SandE] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe gj Hardpan ❑ Previous Application Made: Yes ❑I No ©--New Construction: Yes [+] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or cesspool permiffed if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well ______________Distance from foundation-------------------Material__--_______________- ❑ `�f j .No. of compartments--------------------------Size------ ------Liquid depth--------- ----------------Capacity--------- Disposal Field- Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----__----------- ❑-rX�31�� Number of iines�-------------------- ------------Length of each line------------ -------- .- - -.Width of trench Type of filter material---------------------_---Depth of filter material____--_--____....___..Total length--------------------- --------------------------- Seepage Pit: Distance to nearest well_-/ijQ�( _ Distance from foundation_-12-l.---__.___.Distance to nearest lot line---121:5? --_ \ Number of pits-.......r________..Lining material_._,r�r-t_'C.1C_-Size. Diamete r__-.__s .-_-__---Qepth_.- :X.------- -------- Cesspool: -----_ \ I Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material------- ❑ Size: Diameter_._-_----------------- Depth Liquid Capacity '-------------_-- gals. Privy: Distance from nearest well ____--------------------------------------------Distance'from nearest building --------------- I ------------- f ❑ Distance to nearest lot line-. Remo and/or repairing (describe):______. _ -!�1` !"o�� rl -✓ --- � - -------------------------------- ---- .- t ----------------------------------------------------------------------------------•--------.---------------------•--------------------------------------------- ----------------------------------------------------------- ------------------------ --- - ------ .-.---------------------------••----------------------------------•-------------------- ----------------------.-- ----------------------------------------------------------------- I hereby certify that I have prepared this application and that the'work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. >1 (Signed)----------- --- -- -------------------------- C l / !% r A ------ _ ____(O er and/or Contractor) By: -•----.- -- - ------. .. ------- ---- -----(Title)------ - (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - r {� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._..-- -- --- DATE--.------- ---•-------••---- ' ------- -- REVIEWED BY -------------------------------:- BATE- -- V�` BUILDING PERMIT ISSUED-------•------ ------ DAT ---------------------------------------------- Alteratians and/or recommendations., ------------------------ -------------------- ----------.- ------ --------------------------------------------------------------------------------------------------- ------------...----------- --•--------- ._ -- ----- -------------------------------------- - FINAL INSPECTION BY---------------- ------------------------ Date 1 J O -J L ------ ---- ------!V--- -- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWMCD