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Ll_� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) SCANNED Z Issued -t--- 5.3 Applicatiol isherebymade 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. +� JOB ADDRESS AND LOCATION-.___ -._---------- ------- � : Owner's Name.............--4CS1`.. --- .8 tYlTLvIT._._ -. GG -- -------------------------- --------- Phone_'�-_j.Q..�s---------- Address -- -..........s FQ f ~Q K ---------------------------___......----------_--------_------------__----- Contractor's Name..... /l�------- SLY------- cfUX,f---- ------.. _W..C--------------_-- / Phone- �-.�b.q-/-7------- Installation will serve: Residence l� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ° _ Number of baths .1---- Lot size ------. .... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -y0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 00 Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee},) Sep(t�ic Tank: Distance from nearest weIIkQ/-Y�_.Distance from foundation ion__ �a._i..__Ma+erial_� No. of compartments---.------ --._..-Size�. XLi Liquid depth------,7-- -------C-Cap. �ac%it�Y-K�--a -V--�- 9 C - isposal Field: Distance from nearest well N_ AtV 4 Distance from foundation___�ig_f--_..Distance to nearest lot line.-�4/.... ® Number of lines....._...__....____..------Length of each line._._.. 10---....___...Width of trench__ Type of filter material_i_j_._'W,9C(&Depth of filter ma+erial �._ ��.___Total length...----- .............._.._._... Seepage Pit: Distance to nearest well---tj((19�__--Distance from foundation__..�Q_�_.Distanca to nearest lot line._/Q_�__._ Q Number of pits._.../._...._._...Lining mate rial..CC&.?e(gSize: Diameter__--3_�.'.`------_Depth_ _3_41............ Cesspool: Distance from nearest well.___..----------Distance from foundation---. --------------Lining material,------ ------ --------_._._------- ❑ — -- - � Size: Diameter -- --- ---- -- --- - - - - -- - - - - -- - -- -- --.Depth--- -- - ------------------ -- - - ----Liquid Capacity- --------------------------- ( gals. � J Privy: Distance from nearest well--------------- --------------------------------Distance from nearest building_--- --- ._-----------------_.-.._- ❑ Distance to nearest lot line ------ ._----'----------- Remodeling and/or repairing (describe): ---------------------------- --------- ---- _------------------------- 1 ars, S certify that I have prepared this application and that the work will h done in accordance with San Joaquin County ordinances, State s, a�[ndJ,rutkv, e� regulations of the San Joaquin Local Heal+h District. (Signed)---------- t.`_--- -..�---1✓�--��qc-----------�.C. _ __.(Owner and/or Contractor) By: '' e- ------------------- -...---------------------------------(Title) -- - - - - (Plo+ plan, showing size of lot, toes+ion of system in relation to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------- -- p DATE-------------- f REVIEWEDBY------------------------ -------- ---..._.-- -------------------------------K------------------ ---- ' -- ------- DATE---------_- " ...----- --- ---- - - - - - BUILDING PERMIT ISSUED--------------- -... -- --'------------------------------------- DATE_-- -------- - --------------------- Aterations and/or recommendations:. ___..__ / - - ...... .. ... ..t.. . ----------.-------___...._/ - .._._ _ _------.__..-.... ........__..__ ------.__-----_.__ __ _ --- -- ....__..._ .. ......__..._-_--------__--------__- FINAL INSPECTION BY:------- Date__....---� 3,f J-_ ---- ..--------------------- - 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-9-2M 10-92 Revised W-2100