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APPLICATION FOR `SANITATION PERMIT Permit No_r ------ ,'A�ov (Complete in Duplicate) S 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 wit County Ordina e No. 549. JOBADDRESS A D LO,�TI htL_ ---j _1------- --- - ----- ------ -- - --------- ----------------------------------------------- ----------------- Owner`s Name Phone_5__'"----- --7.� -•-- _ _ - _ j Address---- -t- ' ---- - ------------------------------•--------------------- •------------•--------------- ------------------------••---------- Contractor's Name ••------- Phone Installation will serve: Residence Apartment House ❑l+ Commercial ❑ Trailer Court ❑ Mote) ❑ `Other ❑ Number of living! units: ___' -- Number of bedrooms _�v[ Number of baths ---I... Lot;size ---LZ---- -f-- j Water Supply: Public tystem ❑ Community system [-] Private Depth to Water Table _ ft. i t: Sand Gravel Sand Loam Clay Loam Clay ❑ Adobe[p Hardpan ❑ Character of soil to a depth of 3 fee � ❑ Y � , Previous Application Mpde: Yes ❑ No New Construction: Yes No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: septic #anklor cesspool permitted if publir. sewer is available wi#hin 20D feet})GG .. .. �- (N4,9 at i I------------------------------ - -----.---. Septic ank: Distance from nearest welld,� a ce�fro fpun tjon_!_f-------------- No. of compartments------------�]AT__.____S� :.x y _ _Liquid drpth_.- - - ----------------CapacitY----- f� . ----. istance to nearest t I- e�_ y7� - \ Dispos Field: Distance from nearest w �____.._. -stance frorn;foundation__ _il____ _ -Length of each line_________. _ _._.Width of trench____-. - Number of lines---------- � l � I j-------- ------- Type of filter mater �epth of filter material_,,_____ ___ _________Total length_---___J_2d_�______._____________ Seepage Pit: Distance to nearest well---------------------- from foundation_f_.—t_---_._.Distance to nearest lot line______.______.._ Number of pits----------------------Lining material-----------------------Size: Diameter-s__I--------------------Dept h-------.------_----------------. Cesspool: Distance from nearest well_________________Distance from foundation------_.._.._____—L ruDg,rmaterial_____.__.__-___________..___.__--_ ❑ Size: Diameter--------------------------------------Depth---------------------------- ------- LiquidjCapacitY--------------------------.gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest b�ilding--------------------------------------- ❑ Distance to nearest lot line---------- ----------------------------------------------------------`--- .�------------------------------ ------------------- Remod I'ng aind/or repairing scribe -----••----- ----------------------•-------- ---------- --------- ------------------------------------ ----------------• -•---- --------------------------------- #`--------••-------- -------------- ------------------------------------------------------ ----------•-------------------------------------------------------•------- _-------,-A------------------------------------------------ I hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County l 4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) _ � ____Iz,.a.r----------- ------------ ,---- ----.(Owner and/or Contractor) Ai l B--. --------•------------•---------------------------•---- - ----- .--------------Ila buildings, etc., can ------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, g , placed bn reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_9Z____---- --- ----------- ------------------------------------------------- ------ DATE_,-------.-.----- REVIEWED BY DATE_- BUILDINGPERMIT ISSUED-------------------------:--------------------------------- •- ------ DATE------,- ------------------- jj Alterations and/or recommendations:-•-------------------------------------- --'---------- ------------------------------------------------------------------._.....----------------------------- I I { ---A----------------------------- ------------ :------- ------ -wr:::-,;;:�-----------------------------------------------_---- -----•----------------•--------------------- ---------------------------------------------------------------- -------------------------------------- r -----------------------------------•------------------------------------------•- - ----------------------•---------------- -------------------------------- FINAL INSPECTION BY---- ------------------------- -- Date-------- --�--�-�5 ------------ 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 Io-52 Revised W-2100