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APPLICATION FOR SANITATION PERMIT Permit No.�.3.�E_L 1 , (Complete in Duplicate) Date Issued Z/� Applica{ion'is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein described. This application is made in compliance with County Ordinance No. 549. ® ,p " JOB ADDRESS AND LOCATION le�� A S>E.__- ,JsS' X9`0_/7- �lQ ---f� ----IY --� -- e-- I- A,-j— .��:Owners Name _ _0.�'_.��_.�.----�-�t-��-�!'�.�-¢-c,�i°h/__eQn�---------------------------------------- Phone�_ �-=-_+�r.�ie�I---- Address-------------------------------------- ......F,4_&M.(A&_TO.-N r ��C++ fa.(_i Contractor's Name ......--•---- °J.,S '±5?,e its �2 r -----•----- Phone://9.... 6 Par Installation will serve: Resideig ce Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units:11.4.- Number of bedrooms �7___- Number of baths - 1 Lot size ________------------------- _____-----------_------------ Water Supply: Public system'1P Community system E] Private [g Depth to Water Table ��1 ft". Character of soil to a depth of I3 feet: Sand Gravel F] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: e's ❑ No K New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 41 (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) Septic Tank: Distance from nearest wells ± P Distance from foundation-_/ ---- _.Material-------------------------------.---- [� No. of compartments_._ _._/. ___-_- Size- _�f X_Liquid depth_ 6-.�I,__.________Capacity__/ - - V. Disposal Field: Distance from nearest well-_C QDista e from foundation---l-E?-_.__._._Distance fc nearest lot line---------�r Number of lines-------(___.-_ _i}-__ Length of each line---_----- _Width of trench_.` ' �_u_'__ yrn Type of filter material__f_y___ _k.....Depth of flter�materiaL___I ��__--_ Total length__ �_________._ + / __,�- r See e Pit: Distance to nearest well100_ --------Distance fr fou dation---.____Q.........Distance to nearest f line-------- � p ,F- ------ g _ _-- _ __-�-Size: Diameter-- Number of� its__-- _-Linin materiai_�� -.3 ..........Deptn'_ _� "------------- � Cesspool: Distance from nearest well----_-------_----Distance from foundation..-._._. -______Lining material--------z-__--___________.______-__. ❑ Size. Diameter---------:------- ------------------.Depth------------------------------ --------------------.Liquid Capacity---- R--------------•------galls. Privy: Distance Nom nearest well ____.-.__ ------------_________________________Distance from nearest building__ ______ ------------------------------- El Distance to�nearest;lof-line___--------------------------------------------------------------- �I --•------- ----•----.�-•- ---------------------------- 0 III' ' ./`• ' �,. 1. Remodeling and/or repairing (describe)_____________________ _____________ 'I -------------------------=------•----------- ---------------------------`---------------------------• A 9 __/ ---------------------------------------•---------- 9--- ...--------- ---------`---jp - --------..... ..---- --- ----------------------------------------------- --- _ a !! . ! hereby certify at have prep red t ' applind that the work will be done in accordance with San-Joaquin County ordinances, State la d rule and egu! i ns ofn Joaquin Local Health,District. _ .. . (Signed) -------- -- --------- _ Contractor) _. By:----------- -, = ------(Title)' .__ d'[Lt1. ---------------- (Plot plan, showing size of lot, l cation of system i relat' n to.4 wells, buildi gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY '0, APPLICATION ACCEPTED By ----------- DATE------------- - '- �' ` :�� 11� J= ----------------- REVIEWEDBY------------------------------------------------------------. -----_------- ------- -------------------------------------- DATE BUILDING PERMIT ISSUED J------------------- ---------------- DATE Alterations and/or recommendations:-------:----------------------------------------------------------------------------------------------•--•----_............................... ... ------------------------------------------------------i( ---------- -------------------------------------------- --------•-------- ------------------------------------------------••-----------•--------------------.-...------....--------••-•-----------------------------._----- ----------------------------------------------- ------------------I-----------•---------------------- -------------------------------------- -••--------------- - -------- d. FINAL INSPECTION BY: a. _- 1j� Date---------7---- -------------------------- ------------------------------ SAN ----------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street e14 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100