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APPLICATION FOR SANITATION PERMIT Permit No. ------------ -- (Complete in Duplicate) T. Date Issued ---f/!1//_ 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 i a e in compliance with County Ordinance No. '549. J Ne c.-! No 0 S JOB ADDRESS A OCATION -TO-A-4_R--IJ 5 i_RTE - rj yam,_, s Owner's Name---- -- -- " r7 .��c�FR SO/ Ve O NT,P,tjG.?o/� 2 --•----• -------- Phone----- ------------------•----•- Address--------------••- ---•---------•----.....f✓.(?_-- --F-- _ S•----------C.10 G- -•---------------------------- Contractor's Name-------- --. RI s// C t Installation will serve: Residence s ---------------------.. Phone Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El of living units: J----'iNumber of bedrooms _�_ Number of baths -1-A--Lot size --------- ----"_ - _ Water Supply: Public system E] Community s -------------------------- ystem ❑ Private �--Beeth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay 0 Adobe [t}..-Hardpan ❑ Previous Application Made: Yes ❑f No [P—'New Construction: Yes [j,_No ❑ TYPE OF INSTALLATION ANA SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic Tank: Distance from nearest well--0._O--'__Distance from foundation----- -�?_-� • ---.Material_--C'-C'�_,t��".'e s�.----------- No. of compartments-.-----7r.0Q------Size--- :~--f-3C'- Liquid depth-----4-3`'_ G_D G e --------Capacity Disposal Field: Distance from nearest well--.,:% f._Distance from foundation-__ -`--.-.Distance to nearest lot line-_--IQ. a Number of lines-_----__.--,�-- - -�-__-__,_Length of each line-_.----- 7 ._. �. © 7i Width of trench- " Y� Type or filter materia!-__--1 _-_S-1pDepth of filter material.......1..ds- Total. length--------- Seepage Pit: Distance to nearest well_.?W_`--------Distance from.foundation-_Z O./ �} _[?---.------Distance to nearest lot line,- __Q------"-_ 1 Number of pits.- .--�_--"--_----Lining material"sQ1!1.4-+C_--_.Size: Diameter_--- f'--_--De to-- --.- --- p Cesspool: Distance from nearest well--------------_---Distance from foundation"----_------ Lining material ------------ ❑ Size: Diameter ,.=------------ ----------- ----Depth----------------- -- --------------------- _ 4Liquid Capacity---------------------------gals. Privy: Distance from nearest well ____________-__- Distance from nearest buildin g------------- ----------................. El Distance to.nearest lot line------------- .il ------------ Remodeling and/or repairing (describe):-----?ye_c:j-_____-____-s, a T C J = ---------- ----------•-•-•------•------------------ ----- -- -------------•------------ •------•--------•-------- - --- -----•-------- ---- ----------------------•-------------------•------------------••-----•----•-------------• -----------------------------•------------------------------- 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 nd rules,and'regulations of the San Joaquin Local Health District. t (Signed)------- 1e !Sf ,� ner and/or Contractor) BY= (True) . -- - - - ----------- �ti - C� ." ' (Plot plan, showing size of lot, location of system in relation to wells buildings. etc., can be laced on reverse side). r � g P 4 ------------------ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- DATE-..-.REVIEWED BY -----------------------'-r----- ---- --------------------------------- DATE----------- -PERMIT ISSUED------------••----------- �•---- ------•---------•----------- -- '" --- DATE.-- " r` Alterations and/or recommendations:_-------......------ --------------------------------------------- -- ------- �� ------------------------------- -------------------------------- --------------- ----- ------- ------q----------------------------- -------"-- ------------------------------------ FINAL INSPECTION BY:..-__� y Date- l ---- ------ 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 E$-9 145446 ATWOQD