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I APPLICATION FOR SANITATION PERMIT Permit No. -----i...1. 7 _ (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 LOCA _ ON....._. ,.._ -•/ � IV14 ✓�..� l.t................... ... Owner's Name..,;_::r _ ..<--- -''•-----• .. -------I..._....._I....._ Phone ....---•.-- -----•--• ------- • t .......................•--•-•........---..... -•----•. Contractor's Name------ --...��f1/�✓^� � r 7 ------...--•................... Phone.;55_Z1,---1; -,I-) Installation will serve: !Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '_. Number of bedrooms _.3.- Nb _.._ Lot size ... g 1_ Number of baths ...t � = --------------- Water Water Supply: Public system r[ j" Community system ❑ 'Private ❑ Depth to Water Table�a�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan E]r s Previous Application Made: Yes ❑ No W_- New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septiR tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanta from nearest well.................Distance from foundation.___....---._.._.--Material....._._....__. ❑ N' 0101compartments.. ... ...._._.---...._.Size.............•......._........Liquid depth._.----_-••-•--•----•---Capacity..... Disposal Fie' r Act it nearest well-------........-Distance from foundation.................... to nearest lot line............ ❑ Nu'mber Ines.._....__.-.._.. ------ ..........Length of each line------•------ - -----------Width of trench.....----- ----•----•---�-------- Type o ,Iter material_________________________Depth of filter material........._..._._.__Total length............... .............. Seepage Pit: Distance to nearest well.._A//477?.�Distance from fo��u�r�kd��tt'ion___-!:-2.......Dig,?nc to nearest lot link ��.. j� Number of pits....---/_-----_--.._.Lining material. .h°-lo �'�4 6fi'e: Diameter.--._- 'p�--.---Depth.._..-�_�?•................ Cesspool: Distance from nearest well................-Distance from foundation.....................Lining material..................................... ❑ Size: Diameter. _--Depth..................`..................................Liquid Capacity.................. gals. r Priv t y: Distance from nearest well..,..............................................Distance from nearest building----.................. ❑ �� Distance to nearest lot line_._'..:...........:.....•. ............... .. Remodeling and/or repairing ('describe):..................................................................................... a ................ _-•......................----__.----•--------•----•--•-•-.-----•-----.-_--------•---___---•-•--••••--•----•.._..-•-••-•---- •_. . ..--•--.........................._......-••-•••••••--...._._....-•--•.....---•••••---••-----•-•-....---••-----•-••••-•••--........__.-••--••----•--......-----•-•-••._...._... r ................. ............... -.--•------•----------------•---------------------- ................. I:hereereby ce i that I have prepared this application and that the work will be done,in accordance with San Joaquin County ordinances, Sfdfe law , and rules and regulations of t an Joaquin Local Health District. I (Signed g - /------ - r�R�'-........................................---••- (Owner and/or Contractor) Y:--•- 7 �� --.--..........................(Title)..---... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............. --- --- ...-.......................................... DATE REVIEWEDBY. = .......:............ ..... •-----•-• ......--•-• --...-•---...---•-••---..._.... DATE--- _. BUILDING PERMIT ISSUED ........._•----•- --.... DATE..---... . Alterations and/or recommendations:._........_ �-� / ..........................----•-••-------------•........_._..-•-....._... --- !--•• --••-••••-.._. -. •�'� "_� .. c s)•------ •---•--•---• ............................................................................................................................ .................... ...................I........................................................................ '...._.... .... - ._._V....:...... . .....•_.•-___.-_•...........................---....................................-----................._.....--•--••......._..._.........._.... FINAL INSPECTION BY:'- -/ ... ..........:...:...... .......::.... Date_—.... 4..�...-_.._.a........_.............. 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