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1 lA APPLICATION FOR SANITATION PERMIT Permit No.s ../.......... (Complete in Duplicate) ra'y Date Issued Appliceion 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. P JOB ADDRESS AND ; OCATION..........>� �- /��-....__��__. `�. ............I'` Owner's Name. � { a -- ----- - •--•-- ------- -----=-- Phone------------------------------------ IJ -- ----- --------------- -- 2 V Address -- ' ... - ,. ^ ----- --------- ---- ------ ..__. .. Contractors Name.---- •, ----> - ---------------•----• -••-••-_- •---- Phone --•• •. . ••---_ ----- - Installation will serve: Resid ce Ila Apartment House`❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r.cif b�- Lot size_9 ',t�.��Yt.X..�l . . ---- Nuc�l Number of living units: . Number of bedrooms ae .-u �IfI ,._ ____ .� .. Water SuPPIY' Publics stem Community:system ❑ Private � Depth to Water Table" ft Charactr of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam. Clay Loam ❑ Clay ❑ Adobe[] Hardpan Previous Application Made: Yes ❑ No<U1 New Construction: Yes,N No ❑ - T TYPE OF INSTALLATION AN&SPEIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (' ve p. 1 Septic Tank: Distance from nearest well.---,lee l Distan 'from f- a,-on.....1d.........Material_ = No, of compartments...__,i� _ Size. SS Liquid depth__.___. ,/� .......Capacity art a - - .1 . P tY Disposal Field: Distance from neares#,well 1601 .Distance from-fr'undation Distance to nearest lot fine . Number of linen-. ......a4 ___ jLength'of each line ...... .............Width of trench. Type of filter mate it alr ��'__ �}epth"of filter material......1. ---------Total length -- 4K, Seepage Pit: Distance to nearest rb I-----------------------Distance from foundation ......._ .Distance to nearest lot line ' ❑ Number of pits....... ... .......Lining material._.._...................... Diameter.__.,._-.......................Depth................................ Cesspool: Distance,from nearest well -----Distance from _. ._.., fountion---------------------Lining materia l--------------------___________ ept ..,.- L❑ : i rid Capacity. =' Privy: Distance from nearest well_..._ __________ ______ ____________Distance from nearest building .7g Distance to nearest lot line., - ry _ Rem g and/or repair g (describe) .. lr �4a ! ,` ----------- -•--••-------......................................................................-•-•-•-- ---- - ----•_-•--------------•----•--. ---•---- ............. -•--- --•--- _ r ----••------ ------- - - -------- •----- ------ ------ -.----- --- •--- -------- •-----' --•--- ...................-----------........................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances St to law;, a. rules andLvigulationIM)f #he,Sen Joaquin Local HealthstricF. ..._ . . I ..._.. - .........( 'and/or a4 ------ By......... (T ) ------ (Plot plan, showing'size of lot, location of system in relation to wek.buildings, etc., can be placed on reverse side): FOP.DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----- ----- - -- -------- -----------------. .............. DAT- --------------------- REVIEWED _.._.... -- -------------- REVIEWED BY. _ --- DATI BUI 1311?laa P l I SLI - ----.=- ---• •--- _..... ...... DATE_' -- ------ ---------- ---- ., ,. .. ., .__ E } . -, s Alterations and/or recomm ndationss................. _.._._... :.. �._..,_...... ___...: .......... , .... i ....-..__: x t - .... . .................................................... FINAL INSPECTION BY:-:.. -'--• ......:.......... •. Date - .......................................,------------------- SAN ----- - SAN JOAQUIN.LOCAL HEALTH DISTRICT ` 130 Souk ricin Streaf 300 Was*rOak Strait 132 Sycamore Sires+ e14;Norib ' '-3F '" µ`ms Stockton, Cali#or h- Lodi, CaliforniaMan_ t 4,-Cates ' Trac to t-9-2M ; Revised W-2100