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APPLICATION FR SANITATION PERMIT Permit No -_ $5 3 v (Complete in Duplicate) c Date Issued --- Applica*ion is hereby made to the San Joaquin Local Health Districtfora permit to•c6iist�ru t',gnd install the work herein descri d. ~u- This application is made in compliance with C un�Qr�linance No. 549. yYUd JOB ADDRESS AND LOCATION__:=- '---_._ Owner's Name----------------------' / 1 -- 5 ��2.------ Phone.1`7 E' IV CL Address__.. - --- -- Z-7------- fir._� ._7�°�.�. r Contractor's Name r -------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel'❑ Other ❑ Number of living units: ___/_._ Number of bedrooms _%3_- Number of baths J._-- Lot size -------7-Z ---Z.&_t Water Supply: Public system 54, Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.❑ Adobe Hardpan'❑ Previous Application Made: Yes ❑ No [0 New Construction: Yes,K No ❑ _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - 4. Septic Tank: Distance from nearest we115Q---_Distance undat+quid depth_ Mater-al--------1Capacity_ ter � 1 `� No. of compartments.__-_--_-- ...._ ..Size____V.____ �. -----�� C� Disposal Field: Distance from nearest well__ ��-_Distance from foundation___._r_Q....._.Distance to-nearest lot line_.____�r__7- ' Number or lines-----3---.- ---_---_ ---Length of each line-------------ln-D-------.Width of trench------------S4-/--_---- Type or filter material_ _.. ____.._- Depth of filter material-------/?� .......Total length___________________ �l fJ / a Pit: Distance to neares well._._s!.1. .___Distance om undation___f._(/,__________. ista��ce to nearest to liner.__._.____ .� Number of its-_ __________________Linin material__ Size: Diameter__- __.___. - Dept __ -- VW P g P 1 Cesspool: Distance from nearest welL_-.--"----------Distance from foundation-----_--------------Lining material__-.----___---_____.--._ ❑ Size: Diameter------------- ------------------"----Depth---- ----------------------------_.-- ----.-Liquid Capacity-- r gals. Privy: Distance from nearest weft_---_____------------------------------- -----Distance from nearest building-------.-----------------------------._----. ❑ Distance to nearest lot line--.- : Remodeling and/or repairing (describe):----- -------------- ------------------- ., -------------•---- ------•---------------------•----------------------------------------------------- -------------------•-------- - --------- -- ------- - -- -------------------- - ------------------------' -------------------------------..._ -•--------•---------------•-----------•--•--------------------•--=- ---------•---- -------- I hereby certify that 1 have prep ra ed this application and that the work-will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - (Signed)--- ___-- _-- -- l�/�� --C -- -------------- --------- ---------------(Owner and/or Contractor) BY: ------------------ ----(Title)---------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)., v FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------------ - ----- =----"--------------------- DATE---------------•- 1! REVIEWED BY - _----------- ------------ DATE - -------------BUILDING PERMIT PERMlT ISSUED -------- -- -- --- ------------- ---- DATE - Alfera�fIlions and/or recommendations:--------4_ _- --- ------------- ----------------- f `-- - �- ----------------------------------------------------------------------------- F1NAL INSPECTION BY:------- / --- ----- - -------------- Date----- _------------------- SAN ---_r .--- _SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore $frost 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWOOO Y _