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Permit No.v�^ ..?... APPLICATION FOR SANITATION PER (Complete in Duplicate) Date Issue 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 compliance with County Ordinance No. SJ9. JOB ADDRESS AN.Q LOCATION------. ....../ ......... G 1 ' �-Y. l7- G Owner's Name < 1 x �F �a° ll- '" ------------- ..... Phone r t Address.-..'..�/✓ -Q,, ,�' lilr�/ /�'� �� ►= --!"it......... -----•-•-•-•--- ........... ........ Contractors Name------------J�--- 4 ` ;._.__. Phone. Installation will serve: Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑•�►M��otel ❑ Other Number of living units: __�_-_ Number of bedrooms ._3-. Number of baths .1-__• Lot size -__ 4-._X•--- _ ------------------------ Water Supply:. Public system ❑ Community system ❑ Private 10 Depth to Water Table /Q-_ ft. Character of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam jK Clay Loam ❑ Clay ❑ Adobe❑ Hardpan El Previous Application Made: ,Yes ❑ No IS New Construction: Yes N No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: p � Distance from nearest well--j2;)p S No se tic tank or cesspool permitted if public sewer is available within 200 feet.) r� ,1 p _•Distance from foun�lrFi �� ..._.MatertaF No. of compartments �/q y _Li"-Liquid depth �j, /C_ -_-_-_Ca acita_ p e.jl f-+�---- / q R `ii P Y - Disposal Field: Distance from nearest well_ ` ._Distance from foundatio�...j.. Dstance to nearest lot`' % Number of lines... --------_- Length of each line4"/_f=5A!n2Vidth of trench__ Type or' filter material_. Q. Depth of filter material_•.�._/� -`_Total length-__. . --------- Seepage Pit: Distance to nearest well------------------_---Distance from foundation___;_ .............Distance to nearest lot line.--__-_-___._-----0Q ❑ Number of pits----------------------Lining'' material---_.._..----.----.----Size: Diameter----------------------.Depth,----------.------.._............ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material-----------------------------------... El Size: Diameter-------------------------------------Depth--------•--•-------------------- ---------------Liquid Capacity............................gals. Privy: Distance from nearest well-_--____-__- _______--______________-----___Distance from nearest building------------------------------------------ 9 ❑ Tstance to nearest lot line------- i--------------------- ----------- ----- -------- ----•---_ .- ---•-- ......--------............ ------ Remodeling and/or repairing (describe) -� WjRr------- 0-1 { ,�` { ..........................•---•-----•----••--••--------• ------.----- -----------------•-----•-------------••-----------------------------•-------•--------------------------------------------------•--------------------------- ----•-----•--------------------•---•-----•--------------- 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 J aquin Local Health District. Aft * / Owner and/or Contractor e - (Signed)----••......-• I— ---------------------------------------------L ( / ) By:.....-------••---•-•-•- -----------------------------------------------•----------------------------------------------------------(Title)------- &_191-1-' 4_,---------------------------- '7 -------- -----. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F9 PARTMENT USE ONLY , APPLICATION ACCEPT D BY./ ....-----• DATE REVIEWED BY --------------------------------------------------- DATE...----- - BUILDING PERMIT ISSUED/..................................................................................................... DATE.......................------- Alterations and/or recommendations--------------------------------------------•---- ----------------------------------------------------•----------------------------. -------------------------------•---------------------------------------....._..........----------...--------------------------...-------•---•--------------------.........-----------------•---------•---•-•---•--••-------•-- ------------------------ ---------------------•----------------------------------------------------•--------------------------------------------------------............................................................... ------------------------------------ -------------- ------------------------------------------------------------- -------------------------------- ---------------•------------------------------------------------ -. --- --------------------------•--------- ------ •-- ---- ----- ----_. ... --------- -------------------------------- ---------------------- -- -- - ----- FINAL INSPECTION BY:..----- 4V----- ------------- ---------- Date---- J- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Streef 300 West Oak Streef 132 Sycamore Street 814 Norfh "C' Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100