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a�a APPLICATION FOR SANITATION PERMIT Permit No. __.1-_7r. (Complete in Duplicate) 9y 1 Date Issued J/? 7.�^ Applica+ion 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. t 1036 S_ AV _ '�..�, f _, r � JOB ADDRESS AND LOCATION------ Owner's Name r —.- ' Phone -------------- Address-------- � :_r/ • Contractor's Name_-_-------CtJ`!/I-C/ - ------ Installation will serve: Residence [) Apartment House E] Commercial ® Trailer Court ❑ Motel [] Other-❑ I;, Number of living units' �_ _= Number of bedrooms _A/A%,Number of baths _-9:T Lot size ______ G? -.:.__K .-.I- 7 _______________ Water Supply: Public system-g Community system ❑ Private ❑' Depth to:Water Table 1 '. J Character of soil to a depth of 3 feet: 1Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑. Adobe Hardpan ❑ Previous Application Made: Yes}❑' No [ New Construction: Yes No El ` I TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) 4�_ Septic Tank: Distance from nearest well;__��'t�-:Distance from foundation____��_____�___.Material___--------------___��------�__ti___� .______. U� I-V , � ® No' of compartments__________.._- Size__.------- --X f___Liquid.depth_____Z�_-.-__-____-'Capacity________._.��_.___ ,,. 1 a . i Distance from nearest well__/6-Le Distance from foundation_____7__ 'a Distance to nearest lot line__��____-__ Disposal Field: well-A/6-Le—Distance ----•-- � �- f - [�- f tl , g -s---,Width,of. trench-- = T u ebos filter rmateriaL___/fi:__.�5, C�',Length of each line_________ 1 '- r e loth of filter Material.-_-_f_'��__._�F,:__Totel•�length___-____-��_______________________ Cl Seepage Pit: Disance to nearestjwell____ 'seance from fo ndaiiq ____� d_ __�.Distan� to nearest lot line______` _ r ' "Number of pits-----___j-------- --Lining material__jf._e-. -S Diameter ., � ' Depth ! i Cesspool: Distance from nearest well-----------------Distance from foundation-------------- material_________________.__._____________- ❑ Size: Diameter------- i- -----------=------ - - Depth----------------.- --:------------------------------Liquid Capacity-._-------------------?_gals. A Privy: Distance from nearest well---------- -----i---------------------------f-Distance from nearest building--,-------------------------------_------ C ❑ Distance to nearest lot line-------------- - _., .«,-- -.. . .. �.: ------------------------- ------------------------------- LAT,_ ----------------- --------- Remodeling and/or epairi (de tribe):_----_r ---.__- -----_ � 1 �- ---- `�*'--------• �- -----------------=--- - - -------------------------------------- --------------•------ " --------------- i s I hereby certify_th�t I have prepared this application and that the work will,be done in accordance with San Joaquin County 3 ordinances, State.Xaws, nd rules and.regulations of the San Joaquin Local Health District.all ' Lrj s 1 r (Signed)-------- ---__- -- - -- - � . tl - -= O ctor) --------------------------------- .4 Byr� ';2 - - {T e) __ itl (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 ( 1 APPLICATIONACCEPTED BY---:------------------- ------- ---- -------------- -------------------------------------- DATE------- ------`--------------------------------------- REVIEWEDBY--------------------------- --------------------------- -------1--------:-_---------- DATE--'-- ----------------------------------------- ----------------- s BUILDING PERMIT ISSUED------ _-- ------ -------------- -------------- •=------ ._. DATE.------------ - -------�-----------------•---•--------- ti. — # Alterations and/or recommendations----- --------------`---- -------------.-.---_-• ------=------- -•-----•-•-------`------------- --------�- -------••-•------- .� ------•---•-------------------- ----------•--- ----;----------------------------=`----- -•-------------•---- ------------------•---------- ---------- --- •------ -------------------------------------------------- f _ -----•------- ---------- ------ ----------`----------------=---------- ' '------ --------------------- --------------- .f, -------- -------------------------- a .w..M,r r FINAL INSPECTION "BY:-' = - ------------- ----- -- Date;___ ___: -'� ISAN 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 1 Revised W-2100