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&,_:� 3 3 a (/_ ."SJ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. Date Issued _____'!% Application is hereby made to the San Joaquin Local Health District for &. permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 \ JOB ADDRESS AND ATION•--,j_- --- -- -� � ----- = ---------------- ------------------------------==-------------- Owner's Name------ ---- -�`r`----•---t[9 _ - - ----------------------------------------------------=----------------------------------Phone.-----_----------------------------- Address--- = Contractor's Name - � �;-- - � - - -� - - - ------•---------- -•-•-----••----,� '�--------------------------------------------------------------- Pham r , Installation will serve: Residence`�Apartment Hou"se- ❑ Commercial ❑ Trailer Curt otel ` .,. ..� � [] �..M ❑ Other ❑ Number of living units: __/__ Number Qf_bedr•©oms =_-Number-of baths __/_'._ Lot size -----------------•_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _ , lftt. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑Clay Loam ❑ CI y ❑ Adobe ardpan E] Previous Application Made: Yes ❑ No Rg--'—New Construction: Yes ❑ No �HA/VA: Yes[} o ❑ ��„�,•� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or` cesspool permitted if. public sewer is available within 200 feet.) s r/1 from foundation Mater' --a a eptic�aOn. Distance from nearest well -________________Distance No. of compartments---------=------ ------Size--------�'--=---•----------------Li •d depth ---- -------------------- Capacity ------ ---------------- Disposal Field: ��,�istance from nearest well.fy_ Distance 4fro f�e_ _Distance to nearest lot line-_______-_. IE51, aNumber of lines ------------------Length of eat l�-a� _____Width of french___._z -_ /s - -- rr Type of filter material__/_ i� �De th of! filter material_-__. f�__.__Total length_____ 1 _AA Y p '� p .l�i� Seepage Pit: Distance to nearest well�l��1�.:,Distance om f undation___ a._�.... ante to nearest lot line-__ ________ --- Number of ---------- X' Linirg material.__ .P _-.Size: Diameter -.--195 ---------- Depth ------- &�:�-------- _______ I Cesspool: Distance from nearest well ----------------- Distance from ❑ Size: Diameter---- ------------------- --.----------- Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------- ______________________________________---Distance from nearest building ____----__.________------____________---. ❑ Distance to nearest lot line.-------------------------------- Remodeling ------------------------- \ Tom.- � �,1 Remodeling and repairing (describe}:!G--�------------------------------------•--------------------------------------- i ---------•--•-----------------------------------•--•---------------------------------------------------------------------------------------------------------------------•---- ----------------•------------------------------- - ----------------------------------- `--------------------------------------------------•-------------------------------------------------------------', ' 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, an rules and regulations of the San Joaquin Local Health District. s. (Signed)------------•- - -- ----------------------------- (Owner and/or Contractor) gY:---------------------------------------(Title)---------------------------------------- ---- ----------------- (Plot plan,, showing size of lot, tion of system in .relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------------- ---------- i--------------------------------------- DATE-------- r'} REVIEWED BY-------------:----------------------------- DATE--. -- --15----------------------------- BUILDING PERMIT ISSUED----------------------- ----- ----- -------------------------------------- DATE Alterationsand/or recommendations: ----------------------------- ----- -------------------------------------------------------------------------•------------------------------------------------- -•-----•------ --------- ° '-------- -• , %,... A 0------- 8-------- 8.-.a`n_`----A4Jtk-----b----c-`-'--- �--i---r,/---------------------------- --------------• ---- - ----------------- ------ 7 ---F---.cam---- FINAL INSPECTION BY: ----------- --="__ z,-1-------------------- ----------- Date.---------- -------------------------------------------- SAN-,JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stre®t 300 Wesfi`Oak.Street �' -'13`2-"Sycamore3Streef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -4-2M , Revisea 1-57 F.P.CO-