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APPLICATION FOR SANITATION PERMIT Permit No.A_34-_,.�--- (Complete in Duplicate) Date Issued Application 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-----71 ---OPC7 onto P------------------------------------------------------------------------------------------------------------- Owner's Name-----oda--('a----evp ------------- Phone------------------------------------ Address-----------------------•-----Y_44a ------60---`----- NVI-0------------------------------------------------------------------------------------------- ------------------------ Contractor's Name �1 `F��_✓ 1 `> - ?- sf-oJ/ IAC' Phone s1.7-_._. `1-----9 Installation will serve: Residence [�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/____ Number of bedrooms __ _ Number of baths ________ Lot size ------------------ Water Supply: Public system ®-<ommunity system '❑ Private ❑ Depth to Water Table '10-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe —Hardpan ❑ Previous Application Made: Yes ❑ No R"'New Construction-. Yes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-________________Distance from foundation-------------------Material-________--__---______________________-_-___--_. 7'fA16- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line________________ § ' Number of lines-----------------------------------Length of each line-----------------------------Width of trench----------------------- . material �\ Type of filter material_________________________Depth of .filter Total- _________.______-___._____________._._____ . ., - =�-T--� :.._;.,,. :.. -rt - - fir'�•-"-�:;"-°! Seepage Pit- Distance to- nearest well_�tl��(?'�s___Distance from foundation___ ______.__.Dista a to nearest lot lin`__.o-__________ Number of pits----/----------------Lining material__3XIC-K----Size- Diameter__Z"525-__........Depth-__ l'+�______________-____-_ i IG Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material..................._________________. ❑ Size: Diameter--------------------------------------Depth---•----------------------------------------.--------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________-____-_-____-----------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------------------------------- ----------•----------------------------------------------------------------------------------- • Remodeling and/or repairing (describe):____-c54>lF_l -1C- -"r - -- FA-1L41�Lr -- �Q---- -��- ¢' - . ,------------------- ------- = -------------------------------•------------------.:-----------------------------------------------------------------------------------=-------------------------------------- -------------------------------------------------------------------------------------•---------------------------------------------- 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)_^_ .* r_.-- -1_ ---------------------------------------------------- -------------- (Owner and/or Contractor------------) --------- -------- -------------------------------------------- (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 APPLICATIONACCEPTED BY ----------------------- ......... ---------- --------------------------------------------------- DATE-,-_-------------------------------------------- ,.,r REVIEWED BY_-------------------------------- ----------- -----------------------------------11------- - ----------------------- -__ DATE------�'��-f------------------------------------- BUILDINGPERMIT ISSUED------------------ -------------------------------------------------------------------------------- DATE Alterationsand/or recommendations---------------------- ------------- ------------------------------- -------------------------------------•--------------------------------------------------- ---------------------------------------------------------------------------------------------------------•-----------------------------------------•----- " ------------------------------------ ------------------- --------------------------------------------------------------------------------------------------- ------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------...-------------------------------------------- -- FINAL INSPECTION BY: --------- Date ! 9 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 8-51 Revised W-2100