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I APPLICATION FOR SANITATION PERMIT Permit No. ...2!-_q (Complete in Duplicate) Date Issued Applica�ion is'hereby made 40 the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compiiance with County Ordinance No. 549. 11, JOB ADDRESS AND LOCATION �0� ` -`sp --- �� '�� 'E/------------ ------------------------------------------------------------------ i �p + . - ' R.....l--!_M j-AACr- . 1 . a "----------------- -------- Phone --------------------- r Owners Name__ _ Address ------------------------- _ } Contractor's Name.. ��y------... 11 1*-' - ---------------------------------=---------- Phone------------- Installation will serve: Residence [7�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ • i1 Number of living units: --- Number of bedrooms- Number of baths -,/-.-.Lot size .r._�__________________------ 4 Water Supply: Public,,5yste;m_9_,_Community-system-El--.Private-❑--Depth to:Water Table 625- ft. Character of soil to a depth'of 3 feet: Sand ❑``-Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe []=-hardpan Previous Application Made:1 Yes ❑ No [} few Construction: Yes Eg-14o❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { Il, Septic Tank: Distance' from nearest Distance from foundation---i _ ___�_._..lvlaterial.;,-e G.._ f_-- -----_--. No. of compartments____L....C�( ._L._.___Size___�ra__�Fff___Liquid depth__._.63___.__..___Capacity..l _-�_- �' Disposal Field: Distance from nearest well_ttJ&��6bistance from_fou dation-_-- _-__--___.Distance to nearest lot line............. Number.of lines------- _---- -- ..-Len th of_each-rline �_0.A_-_S1s2......Width of trench------�_-y------------------- Type ofjilter mateerrial__�.-��...5_._Depth of filter material__----- r..._._Total length------e70-1-------------------------- ge Seepait: Distance to nearest well_A✓a? __Distance from fcuncdation____�4.r-.Distancj�to nearest lot line_-`4�_---__- I, Number of pits-----/-------------Lining material__ t:4._J1G�_Size: Diameter---- `----- ----Dept h-----JJ_.__--------------- \ Cesspool: Distance from nearest well-----------------Distance from foundation_.----------.;.-._._ Lining material--------------------------------- O ❑ Size. Diameter-------------------=----------------- Depth-:--------------- --- -----------------------------Liquid Capacity----------------'-------- -gals. R Privy: Distance from nearest well___.:----- ____________ _______'___Distance from nearest building w ---------------------------- ---------------------------`------------- � ❑ Distance to nearest lot line--- ---------------------------------------------• ----------------- U Remodelin and/or repairing describe :-____'c_.1 __ __T-:_ __.:... .. --------------------------------------------- --------------•--------------------•-•------------------------•--------- - ------------------------------------- ------------•--------------r-------._-.. ----------------------------------------------------------------•---------------------------------•-- ------------------------------------------ --------------------------•-----••-----------•----------•--------•----•--------------------------------------------------------------••-------_ -------------•---------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F ordinances, Sta ws, and°rules and regulations of the San Joaquin Local Health District. �� (Signed) !` S c- ------= er and/or Contractor) ,�fl B �7�Title) = J9 _ (Plot plan, showing sication of sys+em in relation to wells, buildings, etc., can be placed an reverse side). ,I FOR DEPARTMENT USE ONLY. i APPLICATION BY -------------------------- ------ DATE-------- ----- �- �- - ---------------- --------- REVIEWEDBY__ACCEPTED� --------- ----------- --------------------------------- DATE--------- - -------)------------------------------------- BUILDIN ------------------------------------ BUILDINGPERMIT ISSUED ----- ---------------------------•------- -•---- DATE..----------- --------- ------------------------- Aiterations and/or recommendations-------------- ---_-- - ----- ----- - ----------------------------------------------------Z--•-----...--•.. ... ---------------•--- -- �- ----- - ---------- ---- -------------------------------------- ------------------------ ------V---------------------- -----•-------------------- --- --- '~'------ = ----- ----- --------------- ---------- --•-------------. - -•-- i FINAL INSPECTION BYm. (� ;�------------------------ Date.------- I r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street' 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I� Lodi, California Manteca, California Tracy, California _ E5-9 145446 ATWOOO ,.