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1 u APPLICATION FOR SANITATION PERMIT Permit No. �{� (Complete in Duplicate) / - 1 y Date Issued �eAl pplication is hereby made to the San Joaquin Local Health District for permit to c n q p o strucfi and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. 441 (.a¢s! E �F�ci2 fTu� Owner's Name Ute/ oj_' ---------------- Phone 17� `�7 7 .� --------------- Address---- `J " dl/Q-��L__�� _ --------------------••------------------------------------------------------------------- Contractor's Name---------------------------- --------------------------r------A4 ...' --------- ---_- ------•--------------- --- Phone---•---------------- Installation will serve: Residence, f Apartment House ❑ Commercial ❑""Ta le"r"court ❑ Motel ❑ Other ❑ Number of living units: ----/-- Number of bedrooms-7-- Number of baths ./---- Lot size ------ 6 ------------------------_- Water Supply: Public system Z& Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe,9 Hardpan ❑ Previous Application Made: Yes ❑ Nog New Construction: Yes.® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----_.__._----._Distance from foundation_ -------------..Mat rial_`-��A/ a.7� Ise No, of compartments---------- -----------Size- .K- -?C-'.' Liquid depth----- ---- ----------Capacity----- d-C3------ Disposal Field: Distance from nearest well--- --.--------Distance from foundationV ;'-_-Disfence to nearest lot ine-__. Number of lines---.-.-__- ' : ----- ------_ Length of each line------_ � 0-.Width of trench.--------.----�-_--------- - Type'of filter material k Depth of filter_ material ------- _&-r---.-Total length--_------------- -- � Seep Pit: Dis#ante to nearest well-.----------- -_---_Distance from foundation-----1D.......Distance to nearest lot line---- ------ Number of pits------_/------------Lining material--- Diamete r-_--_o25.-�--Depth---------- ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Siza: Diameter------------------------------------- Depth--------------------------------------------- - ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------- from nearest building------_------._--------_-_-- Distance to nearest lot c line---------------�------ y "-----=--- Remodelrandor repairing describe): ,--------------------------- -------------------- - G ` � ---------- --- 3 - 3 --- ----------- - -------- --- ------ ----------------- -----------------------------•-----------------------------•------------------ --------------------------------------------------------------------------------------------------- --- ---- , 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, and rules and regulations of the San Joaquin Local Health District. (Signed) ,W, --- ' (Owner ------------------------------------•---------------------------- -------- -----------.(Ow and/or Contractor) B9 r a�` -----------------------------------------------------(Title)----------------------------------------- - ----------------- (Plot plan, showing size of lot,loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY QATE _i- ------------------ REVIEWED BY------ DATE 3 -------- ------------------------------- BUILDING PERMIT ISSUED - ----------------------------------------------------------- DATE------------------------- - ---- -------------------------- - Alterations and/or recommendations------- ---------- ---------------------- -------- -------n t;ti;--------------- --------' ----------------- ---------- ----------- -- ----------- •--------------------- -I-------------------------- -- --------------• --------- -------------------- 7 - ------ -------- n.¢ p - a 7c5 pctx� Nd &a��cc-� Al 7-AIV.� FINAL INSPECTION BY:.--------. __. t K-- }fir G 74A o v /at-ti- C ►� a !.)o�a�s •Q a1 " 4u fit, e-a �J"cs ` S N 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 f .74A06 LTA CU/G[- A �4 • C objAler : /A&,__--7-7' gA E5-9— 0-52 Ile yised W-2100