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APPLICATION FnE`: SANITATION PERMIT Permit No. __ - --"- ' " (Complete in Duplicate) Date Issued __6,cppp//-�Q/`�4 dye- Otv- z! /// 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 corinpliance with County Ordinance No. 549. V4149e JOB ADDRESS AN£ 7L�C�A,r TsIcO aN �N Vi ; 3-J.�-�a �c-k--�Sc�te.Froe------------------------------------ Owner's -------------------- -------------Owner's Name- - -LC Y ' Address----------�1_ r ------------------------------ ,..�----�'-'c-._moo--'-�-'----- -rrc�1-------�-------- ------------ ----- Contractor's Name--------------- ----------------------------------------------------------------------------------------------------------- --- - -- -------------------- Phone----------------------------------- Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trai4er Court ❑ Motel ❑ Other ❑ Number of baths ---1--- Lot size __-�-�Q- -+t-2-� -------------------------- i Number of living units: ---I---- Number of bedrooms __ ; Water Supply: Public system ❑ Community system '❑ Private ® Depth to Water Table _a".3- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes , No ❑ 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---16y.....Distance from foundation____`4�_______.Materi�l�_Ctksl_G�'1° No. of compartments-------------a----- --Size----ii xX_A/---------------Liquid depth------'v--------------Capacity----•-------- --------- ,�6 Distance to nearest lot gine___ ___ Disposal Field: Distance from nearest well----�+�_-_-Distance from foundation____ __ _____"" , � Ile L } �( Number of lines--------------/----"--------``----Length of each line-------1-z0-------------Width of trench------2_1------------- Type of fi{ter material Gr4ee_J----Depth of filter material_-_.__,�"-------------Total length______ _�--.--------- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line----------------- LN ❑ Number of pits----------------------lining material------------------------Size. Diameter------------------------Depth--------------------------------- y �l Weil.............. __Distance from foundation El material________________________ -" Cesspool: Distance from nearest als. ElSize: Diameter--------------------------------------Depth---------------------------------- ------------._Liquid Capacity--- --_----------- ---g _- .. - _ - - —~ ____-_- _Distance from nearest bu2i- r Privy: Distance from neares# well------------ ----- g----------------------------------•----- m ❑ -------------------------------- 'r( Distance to nearest lot line----- -------------- ------------ -------------------------------- ----- Remodeling and/or repairing (describe)-------------------------------------------I--------- --------------------•----------------------------•------•--- ---- --------------•------------------- ------------------------I-------•-------------------------- _------------------------- h - --------------•--•------- ----------------------------------- � ----------------------------------------------------------------- --------------------------------------- --------------------- ' --------- - ------ -- ------ 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. ' ( C tact ) ' (Signed) O wner and/or on r ar Tale By:_ -NIA1 (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 APPLICATION ACCEPTED BY_-__-_._ ___" ---------------------- DATE ---------------------------------------- REVIEWEDBY------------- ---------------- ----------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------- - --------------------------------------- DATE Alterations and/or recommendations---------------------- ----------------------- ------------------------------ ------------------•---------- -------------------------------------------------------------------------------------------------- ---•---------- ------------------ ------ Date_--�-- -----/- .�----r�----------�--------------- v ' FINALINSPECTION BY:___-- __"--- -------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ! 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Stockton, California Lodi, California Manteca, California Tracy. California J ES-9-2M 8-51 Revised W-2100 — - _