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APPLICATION FOR SANITATION PERMIT. Permit No. ------ ----- --_- -7 r� (Complete in Duplicate) Date Issued J1 S3 Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. This application is made.in compliance with County Ordinance No. 549. /f "0 13 470 JOB ADDRESS AND LOCATION. �Iaxa& I4r�i ►a:�>__ -- S-�I__ll-�- 4,�_IN- --- ---------------------- ---------------_---------- Owner's Name-------------------------------•---- .--... X11al e-i$ ------------ ------------ Address-------------------------------------------------- #-- I ----------------------------------------------------•---•--•---------------- Jd,al Contractors Name--------------------------------------- Phone. p 07------- Installation will serve: Residence !c Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ Number of living units: -----I Number of bedrooms .:V Number of baths J____ Lot size __5;3z---*_A_5__0 r______________________ Water Supply: Public system Y( Community system ❑ Private ❑ Depth to Water Table W— ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: Yes 01 No)9,- New Construction: Yes No ❑ Y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well_T1F�, �__Distanc erfrom foundation-/.()---- Material----(7------------------------------ -------- I No. of compartments-1/1----------------- .__ ___ __Liquid depth__ ----------Capacity...._a-�- _�� Disposal Field: Distance from nearest wellA_6*J-_Distance from foundation--- ------ -----Distance to nearest lot line______ __ ---- Number of lines=-_�___________ ______ ______ Length of each line,3_Q de- of trench_19_1_ 1___.__._._______ rn Type of Cter material___(__ P' _ - .-:-._Depth of filter material___--_r-&'r ------Total length____-_-----•-�------------------ Seep ge Pit: Distance to nearest well___gftll____Distanc f m f undation--I� _ _____.Distance to nearest lot line_-_- f 1 Number of pits------I---------------Lining material- Size:' iameter �� Depth----- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--------------`----._____--_� Diameter...... -•-•--------- -----De th-----------•------------------ ---------------------Li Liquid Ca acit --gals.❑ Size: y------------ Privy: 1 Distance from nearest well------------------------------------------------- from nearest building____--_----______-______-_____-.__.____._. ❑ Distance to nearest lot line- ---------------------------------------------------•--•-----------------------------------------•---------- ---------------------------- Remodeling and/or repairing (describe):---------=------- --------------------------------------•---- ------------••-------•--------------------•------•-----------------------•- ---------------------•-----------------•---------------•----- ------------------------------------------------------------------------------•-------------------------------------------- ............ ----••-•------------- ------------------------ --- ------ •-•------••-•-------------------- -------------•-•--------------•-•----------------------•-----------------------------••--------------------------------------------------------- I --------------•-----•-••---------------------------._ .I hereby--cert- y that I have p epared thi application and that the work will be done in accordance with San Joaquin County ordinances, to i ws, ani ules regulati ns of the San Joaquin Local Health District. (Signed)----------- ----------- -- -------------------- --- ------- ----- -------•----------------------------- ----------- Contra r By:-------------------------------------------- = ---•------- -----------(Title) --------, {-��-- (Plot plan, showing size of lot, location of system in r ation to wells, ildings, etc., can be ace on reverse side). w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------- ---------- DATE------Z.Z.--24- ---fti3---------------------- REVIEWED BY - ---------------------------------------------------------- DATE - BUILDINGPERMIT ISSUED-------------- ------------------------•------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations---------- ----------------------------- --------•...•-•------------------------------------------------------..........------------------------------------- -1-----------------------------------------------------i----------------------------------- -----_._. -- --•------------------------------------------------------------------------------------------- ------------------------------------------•----•------------------------------------------------------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------------------------------------•-------------------------------------------------------------- ----------------------•-------------------------------------'- ------------- ------------------------------------------------------------------------------------------------........------------- -------- FINAL INSPECTION BY--------------- f -------------- Date `----' ------------•---- -•- ---•---- 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 "I_1-ES-9-2M ;-_' Revised W-2100