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/ _1-� i 4 APPLICATION FOR SANITATION PERMIT Permit No. {Complete in Duplicate) 5 � Qate issued 3._-1._____ _ s , - • �••, Tom,..--�,..�_.r �.,�_ -•. : - , ,,. . W ,.... � -.- _ .,_..� ..,..� � Applica+ion is hereby made to The San Joaquin Local Health District for a permit to construct and install the,work herein described. k This application is made,in compliance with County Ordinance No. 549. , 06s`7130- 0� ADDRESS AND"LOCATIONQs�M � -------1.. --- ---OiJO Owner's Name T'10 �!s- ---------------------------------------------- M one _.. a_ –_ Aciclrr r J i . . y ----- Contractor's�Name-----_------------------- �_.-�,------�rft -- Phone-------------------------- -------- Installation will serve: ,Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ = NumSer of living units:.__.-_-- Number of bedrooms -_�.- Number of baths ---t--- Lot size --------1_�3----:-/ Ile..=------------------------- t � s r Water Supply:.-- Public'system ❑ Community system [-I Private Depth to Water Table Character er of soil to a dap+h of 3 fee+: Sand F] Gravel E] Sandy Loam ❑ Clay Loam E] Clay E] Ad ,obeHardpan El t Previous Application Made: Yes ❑ No New Construction: Yes* No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: �.(No,septic tank'or cesspool permitted.if.public sewer is available within 200 feet.) _..r — Septic Tank: Distance from nearest well _.s� �._Disfance from foundation-..-/ Material.. . CdYT7.i: -_^. ---- --- -------- Size �� Liquid deF?fh ---- I4 �i Capacity �° No. of compartments- , r Dispo al Field: Distance from nearest well__�V�.._Distance from foundation-------�-:--...Distance to nearest lot line-----;_-.._.- Nu'mber of lines----- .- .---_Length of each line___.___-__6® �4-.Width of trench.-.-_-._..-_7 I–- --- # Type of filter matetial------a-- .___..____Depth of filter material Pf..---_-___._Total length--_------- -?Q._____------------- ••Seepage Pit-. 'Distance-to-nearest well -_ __+._" Distance fromfoundation___----_-----------.Distance to nearest lot line,.-.___-_.•_-.-- : F I' --------- t t- ❑ � p '- .. g., -;_----Size: Diameter------------g--------.Qe Depth ----•-------------�----_-ti-- _ Number of its, -= - . -___ - Linin material_ Cesspool: Distance from;nearest well-------..____.�Distance from foundation____-----^ _- inin materia-_-.-. p "� ❑, 4 ,Size: D.iameter�-------T-----------------------------Depth-------------- = Privy: Distance from,nearest well------------------------------------------------Distance from nearest building------------------------------------------ L ` ❑ -*Distance to nearest,:lot line-c-- - .:= - _"== --------=----------------'---------------- ------"------- ---------------------------- "' Remodeling.,and/or-repairing (describe):----------------- - -----• -----'----=--=------- ----=----------------• ---------------------------------------------- 4' E 1, 1 _ F - y rf -------.f--------------------•-----------•---•------------------------••---------------------•-F----------- - •---------------------------- ---€--------•---------- ---------------------------- ------------- ----------------=-- :------------------------------------- ------------------- ---------------- ----------•--- - -- - -------------------------------------------- -------------•- -----------------------------•-------. ------- 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.. - _ -[Ownerand/or Contractor)- -(Signed).�/ N 11-r y1 __• SIM ."_*mss-.ilF �- ^ ' --------- --------- --------li�tlel--•- _F�.-----.•--•------ --_. ------ By:---------=----_------------•- - ------=- - --------- - �--:--=_ = - (Plot Plan, showing size of lot, location of system in rela+ion to wells, buildings, etc„ can be placed on reverse side). ' x : FOR DEPARTMENT USE ONLY . _ . APPLICATION ACCEPTED. BY-----= ----------------------------- ------;t11_54_ --------------------------------------- DATE---=- - ---------- -- - = = DATE.- : --- ATE. = --- r REVIEWED BY-------------I=-----------------I ----- -------------------------- ------------- - - _- BUILDING PERMIT ISSUED----------- •--••---------- ----------=-----------=------- • DATE-------------------- ------------------:-----�- ---- -------------------- Alterations and/or,recommendations:-_-!--.-....__ w ----------- .. f -_ - - "�� ,. ---- -- - -- --------------------•----- --------------------------------- .. ------••----•-----•--- ------ �., .,. - ------------ --------------------------------------------------------- ' -- _ - ----- --•-•----•--- - --------=- . --- - r a- ----------------------- FINAL-INSPECTION B ---------- ------ ,--- '_ •..� -Date. f�•W Lf' 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 . ES-9-2M Revised W-2100 _. _