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T iM 'i, APPLICATION FOR SANITATION PERMIT Permit No. 9 ��} �� (Complete in Duplicate) g `.h� � eJoaquin Date Issued .5��,��?__Applica+ion is hereby ma to the Saocal Health District for a permit to construct and install the work herein described. .This application-is made in compliance withx ounty Ordinance No. 549. o- --- - -`- -W- `�'JOB ADDRESS A D LOC TION_. ___ 2 Owner's Name----- --------------------� wu, rc ------------ ------------------------ - Phone Address......... Jt..-----...--•------------------------------------------------------------------_-------- .........................--------•-•-- ---•---------„---�--,--``--------------•---- Contractor's Name -------------------- ---------------------------------------------------------------------------------- Phone--D�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 9ther ❑ i Number of living units: _1____ Number of bedrooms __Iin Number of baths __I'..__ Lot size __ .�-p___ -____q J_ ,-fWater Supply: Public system x&mmunity system El Private [I Depth to Water Table _,.S_. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam [] Clay ❑ Adobe[-'Hardpan ❑ Previous Application Made: Yes ❑ No [y New Construction- Yes g-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k Distance from nearest well____________ ___Distance from foundation--------------------Material------------------------------------------------- No. of compartments--------------- ----- ---Size--------------------------------Liquid depth--------------------------Capacity------------- -------- Disposal Fie d: Distance from nearest we]-----------------Distance from foundation--------------------Distance to nearest lot line-_______________ Number of lines-----------------------------------Length of each line-------------_------.-.----.-.Width of trench----------------------------------- Typd of filter material-____._._________._-__--Depth of filter material----------------------- otal length_____________________________ ;_.-_-_ Seepage Pit: Distance to nearest wel - - ---------Distance from foundation_Q-- Distance to nearest lot iifag__. ________- Number of pits---.I-----------------Lining material-h'9-0c--------...Size: Diam ter__-��------.-_.__Depth---------------------------------- - Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material--------------..----_______._________ Q C ❑ Size: Diameter----------------------- --------------Depth--------------------- ----------------------- -----Liquid Capacity------------------------------gals. \„ a rivy: ____Distance from nearest buildin Distance from rom nearest well --------------------- ------- --- ---- 9----------------------------- - --------- ❑ Distance to nearest lot line----------------- - ------ ----------------------------------------- ---------------------------------•------------------------------------ Remodeling and/or repairing (describe):----------------------- -� ---------------- ---- ---------- ---- -- ---- --- - -- --- ------•---------------------------------- 1} ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------•----------------- ------------------ -----------------------------------...------------------------------------------------------------------------------------------------- --------- 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)---- =------------- -------------------------- ------ - ------------------------------- --------------------- ----- (Owner and/or Contractor) -- ------- -------------- B ----------- ------ -�- ------------ ---------------------------------------------- ----------------(Title) �-ru ------------------------ (Plot plan, showing si of lot, location of system in relation to wells, buildings, etc., can be placed on revers ide). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------ ------------------- -- / ------------------------- ------ DATE---------------•--- �, 1 REVIEWEDBY--------------------------------------------- `�-� - ►i DATE ---�- -----------------•------- BU]LDING PERMIT ISSUED ---r -=-l- -In-- 1------------------ DATE. Alter fiions and/or�commendati�ans:__. - - -,�.---------- - --------------- _-�- ..; - - -- -- - --------•------ ---•------•--• •--------------------- ''' -- . G .. . ---- --- = = -- •---------- -- -- ------------ ---- ----------- /� FINAL INSPECTION BY:.-- ---f--- ---�-- -- --------- ------ ------------- �•�; Date---- ------------ --------------------•---- -� ----�/-----` ---- SAN J AQUIN LOCAL HEALTH DISTRICT I30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California 4 ES-5 145446 ATWOO❑