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APPLICATION FOR SANITATION PERMIT Permit No. .....(.•--`----�--.--.- (Complete in Duplicate) Date Issued ___344�. 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. pp •-- JOB ADDRESS AND LOCATION------------ Owner's Sa u - ----- -- ----- '� Owner's Name------7;7&??_.'--•------1 ----------------------- --- -------- - Phone___rte--------•-•-------------- Address------------------------------------------------------ -------------------------------------------------------___-----------------_-..------------------------------------------------- Contractor's ----------------••---------------------------- Contractor's Name--- Y_Y�Alim/.••---. ----------------------•-------------------- -----. Phone-*A....4-AP-i&- Installation -AP-i •-Installation will serve: Residence ❑-`A�partment House ❑ Commercial ❑ Trail r Court ❑ Motel ❑ -Other ❑ �� l Number of living units: ---/___ Dumber of bedrooms _��Number of baths _____-_ Lot size ___5.____ __D�_�.®"Q_.____.___._____._ Water Supply: Public system ©'"/Community system ❑ Private ❑ Depth to Water Table 1-r ft. Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam E] Clay Loam E] Clay E] Adobe I�ardpan E]Previous Application Made: Yes El No --Gravel Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-�!'t-�-_Distance from foundation_�D--l-----.Material-__ ___ _______ _________ �...._-__-- No, of compartments --------------Size-- -'�sC �1' -« Liquid depth- ` �- Capacity__ ---_--------__--. p !- - J- Disposal Feld: Distance from nearest well-__/ n - Distance from founda9'on�_l 1 __ ____Distance to nearest lot line____l�__..tj Length of each line,- __,L_____.__-' 'Width of trench-- _ __ .-____ __ Number of lines------ --_�_ - � -... �---- Type of filter material, _.Q4r�f._ _Depth of filter material__=f.��t_`=- ..To#al length------- - ____ ______________-...___ Seepage Pit: Distance to nearest.well.. 4,.,_------Disfanc from founclation_s�. _ _..-Distance to nearest lot line_________________ ` ©� Number of pits---- -_--Lining material ------- -Size: Diameter__..________ . --�--- ---- pV 011411104." Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining materia l-_.___________-----.________________. �Ny ❑ Size: Diameter_------------------- ----------------Depth--------------------- ---------- - ---------------Liquid Capacity----------------------------gal s 1 �r Privy: •_ � Distance from nearest well. ------------------------------------------Distance from nearest building 9----------------------' ❑ Distance to nearest lot line.................... . ------ I , y i Remodeling r repairing d scrsbey:-�-------- ,- - � --�"-``'".''=___r-----------"•----r-�--r-:�'--------------=-------------^ -•------------I---�------'".. r_=l_-«-•--•- ---�- 7 ____4r-" - ----------------•--- =-f__:___.----r F ---:`1 ----------------------- ---- �-�--------------------------------------------------------- ------------------ - ----- --------------- ------------------------------------------------------------------------------------------ ---------------------- --- 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, arsd-rulejDWAI fia of the San Joaquin Local Health District. } Septic lank Service (Signed) ---- ------ -------- ----------------------_ ---- ��r ContractorI-----T1015-50:Eldoracro""-HD-Z=7046---�--- -- �Title ------•---- --------- By:.-.. ---- - ---------Stoslcttfn�.Calif.------•------------- - - - ---- -- •- ( )(Plot plan, showing size of lot, location of system in relation we11s, buildi gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ . . ---------------- ------ DATE----------- --- REVIEWED BY------------------------------- - ---------- - -----------------------------------:------------ DATE---•------------ ---•------------------------•------------ -- -- - BUILDING PERMIT ISSUED--------- - DATE-------------- --- —--------------- ---- Alterations and/or recommend n F '" t - -Aa. ---------- ~/'Y -� - ------- --- -------- ------ ------- ----- --- - , ----------- - -------------------- ---------------- ----------- - �' '�" - ---- - =. ------------------ ; --f. - FINAL INSPECTION BY- - ------------------------ -- --------- -- � Date -- _ 5--------------`---.--------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145445^TW00- 12-54