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Permit f�To. ._ . .. ..... APPLICATION FOR SANITATION PERMIT �/ �/ (Complete in Duplicate) Date Issuedl�_`_Z{�_:-��..�_T Applic ion is herebymade 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----------------------- ----- ---- ------- ;------------------------------------------------------ ----------------------------- -----------------r--- Owner's Name.................................ftw- 7�! 7. C�i2 C-z-✓--------------------------------- Phone-/!" Address...............................................'-?----------- --• • ---------------------------- - -------� -------- ------------------------------ ---------- ------------------------ Contractor's Name------------------------------------------ G�ZJLC�-�-- -------------------------------------------------- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other: ❑ Number of living units: _,I--- Number of bedrooms _Number of baths ---I_ Lot size .._ ......I___ZJ____________________ Water Supply: Public system [e-**I-community system ❑ Private ❑ Depth to Water Table 4-Oft. n Character of soil to a depth of 3 feet: Sand Gravel [-] Sandy Loam [-] Clay Loam ❑ Clay F] Adobe�ardpan ❑ l�f Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ b-,t..� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) $�tic�T�n�: Distance from nearest well-----------------Distance from foundation____--_..•__----_---Material_----_---_---_-__--_--_.----_---__---_-----_..... � -7.. No. of compartments-------------------------Size............................---Liquid depth--------------------------Capacity--_------------------ D' osaI Feld: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. Number of lines___________________________________Length of each line------------------------------Width of trench----_.-.-..__-__-_-__---_--____-_ Type of filter material-_--_.--_---------------Depth of filter material----------------------Total length------------------------------------------ Seepage PI : Distance to nearest well.-14 �?_.__Distanc�fror}� , nd tion__�.�.?.--__-.....Distance to nearest lot line.- _._. Number of pits------I--------------Lining material------- ,- ize: Diameter a�.�� Depth Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-__---_----__-_-----__----_-___--_-_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------•---------------•-gals. Privy: Distance from nearest well _-------.-_.------------------------------------Distance from nearest building...---------.____-_____-__-_-------_--._. ❑ Distance to nearest lot line------------•------•-----•------------------•-----------------•-------------------------•------------------------------•-•-------------------- Remodelin and/or repairing`�t � (describe) :___._..__. --/,�----- -�'-I•--- -Q-- • ----- ----------------- ....... ---------: ---�`- ...........................----------- 0 ----------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------•--- ••-------••-••---•-•----------••--••---•••-•-•-•----•-•---•--•---------•-••--••---•------•••------••----------------------- I hereby certify that I have prepared this applicati n and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulati s of the San JDin Local Health District. (Signed)----------------------Pa-1vL-C*jj------- --- ------- ------- ---- - - - ar-Contractor) --------r%�--- Contractor) -------------------------------------------------- ---- --- ----- ------(Title)-- s-- -I-rn.� _. --�� -------------------- (Plot plan, showing size of lot, location of system in re ion to wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- ------- --------------------------------------------------------- DATE------�-------------------------------------------- REVIEWEDBY------------------------------------- --------- ------------------------------------------------------------•---- DATE--------------- ;w:......---•••................--•-----•- BUILDING PERMIT ISSUED.................................... -- -••----•-------------------------------------------------- DATE..................... cox,"--------------------------------- Alterations -- ---------------------------- Alterations and/or recommendations----------------------------- - -----•------•---------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------- ----------------------- ----------------------- --------------------- -------•--------------------------------------------------------------------------------------------------•-------------------------------------..........--.............................................................. -----•-------------------------------------------------•-------- -------------------------------------------------------------------------------- ----------------------------------------- -------------------------------- ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------`----------------------------------- FINAL INSPECTION BY------ ------------------------- Date t--- - ------------v 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 Revised W-2100