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�' APPLICATION FOR SANITATION PERMIT Permit No. . �"` " f' (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 OrdinanceV. 549. JOB ADDRESS AND LOCATION�l------ --- -------- _ 1- - 14906_-74.----------- d Arr4 /��, /y �j ! ) `�1 Owner's Name------/--1ft_�-1-----d-r..j--�„r-f-- �+L✓L�_1..�-�_/-!�'-�------ -- ��- l -------- -------- -- - -- Phone- Address , ,Gp----•-=- - ----------------------- .-------•---------------------- ------�.e@Y�.:�-----•----------- !' `- Contractors Name----- r' Phone r - -- ` �� f _. Installation will serve: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units:61US Number of bedrooms _ Number of baths _ ______ Lot size. O ----------------- -- ------- - -- --- - Water Supply: Public system K Community system ❑ Private p Depth to Water Tablev!U- ft. Character.of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Cla Loam Clay >��_ Y ❑ Y ❑ y ❑ Adobe k Hardpan ❑ Previous Application Made: Yes (] No Z.- New Construction: Yes E] No X_ TYPE'OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available wi}hin 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foun ❑ No. of compartments dation------- -----------. Material------------------------------------------------- Size- ....------Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well_4��--"�'�'p�stance from foundation.-----_-"----Distance to nearest lot line__r0_"____.. Number of lines________�7� - _-" Len th o{ each line__ H g ��8-�---- ------Width of trench----Z-4_ ------------- Type of filter maferial_ _ A___ f i --Depth of filter material t___ ___ r �p ,�, Total length ---------- Seepage Pit. Distance to nearest weii__._ jistance,ffom foundation___ _____ ___ Number of pits-_-1_ - ---Lining material.._1E '�� "'�fs�a r'e to nearest lot lme _ ,��`� -__Size: Diameter Depth____--- ------------ Cesspool: Distance from nearest well________________Distance.from foundation-----------,_.------Lining material___-___-______-_______----_--- ❑ Size: Diameter------------------------------- ---_Depth--------_""---------------------------------------------- -Liquid Capacity ----gals. �---:" �--�...-�._ -- •---------------- Privy: istancefrorra-nearesf well Distance from nearest building ❑ Distance to nearest lot line----------- -- 9 ------------ Remodeling and/or repairing (describe)_______ i r------------ -- r --------------------------------------------------------------------------------- -- ----------------------------------------- r -------------------------------------------------------------------- l -------- -- - 4--- --- _____________________________________--------_-------_-----------___________________________________________.._____-____________-_____________-_____._._____.__-_.._____-____-__--___._._____-_______-_____________-____-_ I hereby ce 'f that I have prepared this cation and that the work will be done in accordance with San Joaquin County ordinances, State la aArule regulat' ns f the San Joaquin Local alth District. (Signed)--------. -----•0- --- ---- - fl� wne ntractor) (O r d/or CoBY= --- --------(Title)-------- - ------- (Plot plan, showing s e on of system in relation wells, buildings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------- DATE _ -- REVIEWED BY---- - _ ------------------------------------ _ ----- ------------------------------------------ - DATE BUILDING PERMIT ISSUED____________ F � Alterations and/or recommendation`:-------------- _`r"-___-_"--- ---- DATE -- ---------------------------------------- - - ------------------------- - -- ---- - ---------------------------------- ------------------------------ FINAL INSPECTION BY:__ __-_____"---_"""-_ -" i . a------------------ Dafe------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American aroe+ 300 West Oak Street 132 Sycamore S+ree+ 814 North "C" Street Stockton, CeliforaiLodi, California Manteca, California - Tracy, California ' ES-9-2M 9-51 Revised W-2100