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q VS, O APPLICATION FOR SANITATION PERMIT Permit No. _..._. .. (Complete in Duplicate) Date Issued '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. 549. Cj JOB ADDRESS AND LOCATION----,--3---%4_!... t 1 E t Q r-- T._ r Q.t^--------------------------------------------•------•------- Owner's Name----------------------------------=--tT ul`N.......l...... _�'�? t"1----------------------------------------- Phone----1`1"' � Address................................................1e.:S.0A#* �Q Contractor's Name--------------------------- --- ---- --------------------------- ----, ------------------------- Phone.......77!:-946.0- Installation '-`-,946.0Installation will serve: Residence 0!� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ de Number of living units: ____/_ Number of bedrooms -_Number of baths ___L Lot size ...*'5—S-_------- --------_------- Water Supply: Public system.9 Community system ❑ Private ❑ Depth to Water TablepWt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ .Clay Loam ❑ Clay ❑ AdobejK Hardpan ❑ Previous Application Made: Yes ❑ No bf New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well14O0-6_Distance from foundation---t_Q--_--____.Material---C/ _asozAiAs_______________ No. of compartments__--i-___--------------SizeZ`!0"A_ ._ Liquid depth__.172_ ------------Capacity..,.1VQa_-________ Disposal Field: Distance from nearest well.-AgWR.-_Dis}b "from foundation__-��_�_...._. 's ce to nearest lot line_ ....( ►� jNNumber of lines....�________77LL_______________Length of each line_. Q_�____3-1 ."._.Wit of trench,o,Z_?'�__________________ __ V� Type of filter material._ 3 p g -_De Depth of filter matenal____1;S!�________Total length...;? i o Seepage Pit: Distance to nearest well---�fJK.i�-----Distance fr m foundation_30__._..._..Distance to nearest lot line_________________ Number of pits____ ______________Lining mate ria lte_ M:s ___Size: Diameter_��/r----___Depth__Z.I**________-_______ v 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------------------------------------------ ElDistance to nearest lot line----------------------------------------------------------------------- ----------------------------------••--------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------•----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I hav Zparrele is application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule al ionsof thetSBn Joaquin Local Health District. (Si ned----------------------------_---------------� �------ n c) -- ---- - ---- - --------------------------- 9 ) --c--____-- (CwContractor) By:--------------------------------------------------------------------------------------------- -- - ---- -------- ---------(Title)---- (Plot plan, showing size of lot, location of system in relation to Is, buildings, a c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ ---------------------------------------------------------------------------------- DATE �------------------------------------------------ REVIEWED BY--------------- ----- --- ---------------- DATE-- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------4�p---------•---------------------- Alterations and/or recommendations---------------------------------------- -------------------------------------------------------------------------------•-----•-------------------- ------------------------------------------------------------------------------------------------------------------------------•--•----------------------------------------•------.........--------•••---------•------------- ------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------.-----_-------- ------ ----•------------- ---------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------ ---------------------------------------- ------------------------------------------------------------------------------------------------------------- --------- FINAL INSPECTION BY%.---------- --------------------------------------------- Date 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 10-52 Revised W-2100