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"71 APPLICATION FOR SANITATION PERMIT Permit No. ..... ta__GP__�5 r (Complete in Duplicate) I ' Date Issued ._____ Applica{ion is hereby made to the San Joaquin Local Health Dis+riot for a permit to construct and install the work her in des ribe This application is made in compliance with County Ordinance No. 549. Gs. !«� _ f [/ iit � ._"p-- .- ------ - ------------eI�JOB ADDRESS AND LOCATION_ rs�f Owner's Name-------------------------- xA ----------------- -------------_----------- ---- Address. Y� 14/ .._ _#�t ..� - ------- - ' Contractor's Name---------------------••-------------•--------.--.------------------------------------•--------- ----------------------------•- •-------•--- Phone!' ------------------•-•--------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_._ Number of bedrooms _l___ Number o aths __-�__ Lot size ___.!_ -----r ---------- Water Supply: Public system ElCommunity system ElPrivate Depth to Wafter Table V_ ft. 44 Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay E] Adobe C] Hardpan [II Previous Application Made: Yes E:1NoNew Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if 1� . _. p_ub.--l._ic sewer is available within 200 feert.') ep© Tank: Distance from nea-rest we .5r Distance from foundation _.__ No, of com artments' � --------------- � Material_--- --.- t . _ize_ -------Liquid uid de '. ---------Capaut - _______ Disposal F �► Field: Distance from nearest well_. .0_. _Distance from foundation_lD---..._.__.Distance to neairest lot lige_1_____-_-.... Number o� lines � —._ -.. Length of each line___-__6_2�...............Width of tren6' -- Type of filter material__ r- �� -Depth of filter material____../_.9_ Total length______ _ ___________________..-- Seepage Pit: Distance to nearest well__--------------------Distance from foundation___--__•.___._____.Distance to nearest lot line-----..----_.--__ � ❑ Number of pits----------------------Lining material-----------------.----.Size: Diameter-----------------------Depth------------------------------- Q� Cesspool: Distance from nearest well-----------------Distance from foundation______-___..__.___.Lining material�l�:_______._____.__.___..__---______. 3 r_1 Size: Diameter--------------------------- ---------Depth------ ------------------ --------------------------Liquid Capaci+Y gals. ¢ Privy: Distance from nearest❑ well--_ -------------------------- from nearest build ing---.-Distance to nearest lot line - ---------------------------------•----------------------•---..------------------------•---- ----------------------- Remodeling and/or repairing (describe):------------------------------------- --------------------------------------•----------------- ----------------------•------------------_------- -------------------------•-------------------------------------------------•--- ----------- ----------------- ------------- ------------------- -----------•--•--•-•--------••-•-----•---- -------------------- ------- --------------------------------------------------------------.;.--•------------------------------- il ---•-------------------•-•---••-------•-••---------------------------------- •--------•----------------------- ---- --------- 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 rules and regulations of the San Joaquin Local Health District. (Signed]------------- • � � - -f��ur- ' (Owner and/or Contractor) B itle �I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse�side). FOR D-E-PA TMENT USE ONLY APPLICATION ACCEPTED BY---- --t-- � fid. DAT ---`----------- ------------ REVIEWED BY---------------------------------- -------------------- DATE 1- ---------••--------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.- .---------------------1M --- Alterations and/or recommendations:__.._-_.__.- ------- - I ----------------------------------------------------------------------------- ----------------------------- -• ------------------------------------------------- -----------•------------ ------------------------------ j FINAL INSPECTION BY:, . .�+_.- Date...... .-- -- � / 1 --------------- --------- 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 Traelly, California s--9--2M iasaa6 nTwooa iz-sa 1 4'