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APPLICATION FOR SANITATION PERMIT Permit No. i ._.q"1_ . (Complete in Duplicate) Date Issued 1_t11- Applica-lion 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. -2- fbo,_ p6 i F-r pg }i �/Gv b `7 :� ��fi 7o fl i `--4"I _�—/-f uer.4`S �O f�_E-�{�f JOB ADDRESS AND LOCATION `� ----------------------- 1 C/ Owner's Name----` 4Z.A1--1.P-----1_----- 71:•-------• ----- -------------------------------------------- Phone------------•----------------------- Address...... � � ---- 4-- ------- � Vd ------------------------------------------------------------------ ------- -----•---------------• ContractorsName---- ----------- ------- -------------------------------------------------------- Phone------..--------------------------- Installation will serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms _- _. Number of baths _f_____ Lot size .-__- o____-__ (_.� _U_________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table —50 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado6e' Hardpan ❑ Previous Application Made: Yes ❑, No [K New Construction: Yes ❑ No [2g 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_--..5f'____ Distance from foundation_____- _.--._--Material____. __ __._ �' -------- No. of compartments__..___.c>-------------Size----- - --X- 6-----...Liquid depth-------- - --------------Capacity-----P-a---------- `��ll _ . Disposal Field: Distance from nearest well- -----Distance from foundati iQ__4— ''.Di4ance to nearest lot line_ _____U__f___ [ ] Number of lines109 ---------------- ---- ------Length of each line----k.v__a_ °f .�'Width of trench_._.__ - - -------------- T e of filter material____ _ ! 0- De th of filter material_-----fk------4-- ----_ Yp ��- ` --- p � --Total length---------1---1-6---------------------- � Seepage Pit: Distance to nearest well----------------------Distance from foundation ... ._..__ ._-.Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material----------.------------Size: Diamete -----------------------Depth---.---------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------ _____.Lining - material__.___________-_____-----.-_-______-_- Ill ❑ Size: Diameter----------------------------- -------De th.--•------------ ------------------------ Liquid.Capacity-,.._. _:----------------gals. � .F Privy: Distance from nearest well-------------------------------------------------Distance fro nearest building------------------------------------------ Distance _____._____.______________________ ._.Distance to nearest lot line--------- - -------------------------------------------- - - ------ --- --- - 1------------- ---------------------C 1C Remodeling and/or F6pai6rig (describe): --•-------------------------- ---------------------------------------- f�}r�," -------------•------------------------------- - `$ -------------�lE _.�<4_- ::�= - �.�/r! ------------ -----------------------•-----------------t=--------------------------------------------------------------------- -----------•------------------------------------------------------------------- ---- --------------------------------------------------------4-------------------I----------------------------I---------------------------------------------------------------•-------------------------------•-- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State lamd rules and regulations of the San Joaquin Local Health District. {Signed).. - : ---------:.:/�'-Z �-�-------------------------------•- �--------__------------------;-----(Owner and/.or..Contractor.). - -c ----- -- By:.._: _k .•a_��_�''--�fit/'.�C�Z--�e-,,r------------------------------------------•----------------(Title)------- ------------------------------------------�_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). }e _. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED B ---------------------------------------- ---------------------------------------- DATE'S'-------- -------------------------------------------- REVIEWEDBY----------------------- --- -------- ----- -••-•-•---------------- DATE--- ----------------•------------------------------- BUILDING PERMIT ISSUED - --------- DATE---- -------- VN Alterptionsand/or recommendations:---------------------------------------------------------•------------------------------------•- ------------------------------------------------- -----------------------------------------I---------------------------------•-------------------------------------...-----------------•---•--------------------------------------------•--------------------------------------- •------------------------------------------ --------------------------•-------------------------------- ----------- = -- ----------------- --------------------------------------------------------- = 7 / . _.. . .. --------- ---------------------- FINAL INSPECTION BY:-------------------------- ---- . ---. ,.f. Date---- 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-4-2M ; Revised W-2100