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APPLICATION FOR SANITATION PERMIT Permit N4;9---- (Complete in Duplicate) Date Issued _S_77/f_6_j Ap�l anon 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. JOB ADDRESS AND LOCATION........V;u__4------- 16---------- ---------------------- 0 - Owner's Name-----/- �Z...... .�____A�l--- ----------------- 13 - - -Ir----------------------------------- -------- Phone------/V----------------- ----f Address.-----6.". 1_4 ----------------------------------_ A Contractor's Name-------------- ------------------------------------------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence 2- Apartment House [] Commercial E] TraiI7 Court [] Motel E] Other E] Number of living units: I---- Number of bedrooms -,.I---- Number of baths Lot sae .---- --__�__-J_-� -�-=�----------------------- Wafer Supply: Public system 0 Community system [] Private*---Depth to Wafer Table -------- ff. Character of soil to a depth of 3 feet: Sand - Gravel F] Sandy Loam E] Clay Loam [] Clay [] Adobe 2 Hardpan E] Previous Application Made: Yes E] No New Construction: Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS- N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- Distance from 9foundation-----I Q_--------Material__ _ !--------------- ------------------- ------ No, bf compartments-----------I-------------- ---Liquid depfh--------- ------Capacity-----IR90------------ Disposal Field: Distance from nearest weI----�Q-----Distance from foundation-----/_P---------Distance to nearest lot line------5------- Number of lines__---___ 2-------- ---- --Length of each line------q_�_-!74aP-----�Width of trench Type of Vter material____ske-A --Depth of filter material-------)9-'t------Total length-11-Z ------------- - Seepage Pit: Distance to nearest well----------------------Disfance from foundation--------------------Distance to nearest lot line__._____._.______ El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-_._---_____--_____________._______. n Size: Diameter------------------ -------------------Depth------------------------------------------- - -----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______.___--_-------------------------- ElDistance to nearest lot line--------------------------------------------=-----t----------------------- -------------------------------- Remodelingr iria97 Aod/orjpa _,., (clescrilz ---------------------- -— -------------------------------L------------------- ------- ---------- _P1 .-,A,-Y 'A-6 ----4j-4 It K! ..... ------- ------------------- ------------------------------------------------------------------------------- ------------ ----------------------------------------------- ----------------------------------------------------------------- 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 Aes and regulati sof the San Joaquin Local Health District. T, (Signed)-- Rig --- - ---------- ------------------------=--------------------------- -----------------------:--------------------------- -----------------(Ow.ner 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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------4/.1�_�----------------- ---- ------------- DATE------- / % ------------------------- Za- ----------------------- REVIEWEDBY--------------------------------------------C/--------------------------------------- ------------------------------- DATE BUILDINGPERMIT ISSUED..--------------------------------------------- ------------------------- -------------------------.-- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------- -----------------------------------------------------------------------------_-------------------------------- -•---------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------•---------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ---------------------------•--e--------- --------------------------------------------------------------------------------------------- --------------------------------------------------------- -------------------------------------------- ----------------------- --------------------- -------- ------------------------ --------- ------------------ ----------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. ------ Date----- - ------- . _.t4 -, I-_4��_ 13 -------------------------------------------- ------ -SAN----------------- -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 E5-9-2M 10-52 Revised W-2100