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q,� (/A S� APPLICATION FOR SANITATION PERMIT Permit No. �Q-__(a-_7-- I O (Complete in Duplicate) SCANNED Date Issued b��V 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. 54 JOB ADDRESS AN OCATION `3 �Cz r.--------------------------------------- - -- ..... _--------- - Owner's Name........7, ;,{ (�yu p----- 3_p9y ----- - --- ---- --------- --- ... '-- Phone------- -- ---- Address- �J x ----P--r.`:=----------------------------`- -----------------`---------------------- Contractor'spp -- Name---------- --- ---------p'tj--S.-L/-------- ------------.._ ........ / `f 6 a - - - -' Phone_. .. - ----------- Installation will serve: Residence 0 partment House ❑ Commercial ❑ Trailer Court E] Motel Motel ❑ Other ❑ Number of living units: ._.- Number of bedrooms -.�_- Number of baths ---/.-_ Lot size -.� Water Supply: Public system ❑ Community system ❑ Private L✓J Depth to Water Table -_y/J_ ft. Character of soil to a depth of 3 feet: Sand ❑.-Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ea-"Hardpan ❑ Previous Application Made: Yes ❑ No E?' New Construction: Yes No � TYPE OF INSTALLATION AND SPECIFICATIONS: CC e-C. r,;_; , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanker - Distance from nearest well-----------------Distance from foundation----------_.-------Material...__._.-- ❑�L , tc .q No. of compartments- - .. ,-.Size -------..............Liquid depth-------------- -----Capacity Disposal, Field: Distance from nearest well. .y( Distance from foundation------_ __..Distance to nearest lot line,._..?........ r„ Number of lines__.__-_._..� -_ _--.--_ Length of each line.__.___-Er.Q_- Width of french..__a2 y_--.... rr / ------' Type of filter material.-�. .....f s -Depth of filter material------1��---------Total length_.._--__��-..---------------------- G Seepage Pit: Distance to nearest wall---------_...-.------Distance from foundation___.......- Distance to nearest lot line----------------- n Number of pits.----------------...Lining material--------------------Size: Diameter-----------------------Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------- -----Lining material--- ------------ ..___-..._.--___- ❑ SizerDiameter----------------------------Depth----------------- ------------------------Liquid Capacity....---------------------gals. Privy: Distance from nearest well._.-_----_-----__. -------------------------- Distance from nearest building_...__..__ Distance to nearest lot line---_- --------.----._----------_---`--------------------_.-- ------------ ---- - .. --'---------`-----'---..._._------------ Remodeling and/or repairing (describe):--------_-------_----- ---- --------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawy, and rules and regulations of the San Joaquin Local Health District. (Signed)...----...- ---- - (Owner and/or Contractor) By:. ---- --- -' -------------------------------------------------------- -(Title) (Plot plan, showing size of lot, location of system In relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------- ----------- --- ---------------------- ------ DATES- - - -- - REVIEWED BY----------------------------- _.._ --------------. -- - - DATE--;A BUILDING PERMIT ISSUED-e._.___... A ------------------------- A] '- -- AIf do d/of , co endati ns:- r Sas --- ---R ::: - ; : :::: _... --- -- ----------' - ------.................. - - - - ._-_--------------------__--•__....._._....._-----------•------ r --------------------------------------------- ....__.___...._..... . FINAL INSPECTION BY:.__------ �le Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 131 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100