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APPLICATION FOR SANITATION PERMIT Permit No. 91.1 (Complete in Duplicate) Date Issued _:A/l/A Applica4-ion is hereby made-to the San Joaquin:Local Health District for a permit to construct and install fh6 work herein described. This application is made in compliance with Cou-n'ty Ordinance No. 549. JOB ADDRESS AND .LOCATI N---- ---/__42 ------------------------------------- ------------------------------ Owner's Name------ ---------------------- -------- ------------- h ne2_._ --- 13- - --- - Address---------Z12-2-) - ------------II-1 --- --- ------------------ ---------------------------------------------------------------- .......... Contractor's Name-------- ------------- ------------- ----------I_--------------------------I--------------------------------------------------------------- Phone.............................. Installation will serve: Residence,�?' Apartment House [] Co m� mercial E] Trailer Court E] Motel. E] Other [I \ _. Number of living units: _/.-__ Number 5frb'ecrooms Y._ Nu1m ber of baths j --- Lot size -7j; - ------------ -------------- Water Supply: Public-system` Community system Ej Private F—I Depth to Water Table -------- ft. Y L Character of soil to a 'depth of 3 feet: Sand []' Gravel E] Sandy Loam El Clay Loam-E] Clay E] Adobe Hardpan ❑ I I *-- t z Previous Application Made- Yes E] No New Construction: Yesikk No E, rt TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee S tic Tank: Distance from nearest welIA&W-e-Distance from foundation---,/Q---.--'----.MateriaI-J--------------------4�- - ------------- e - -oil, N07. of compartments--- ' ----------------Size- `—----------------S i z e A--i,.' Liquid depth----4- - 4 ---- ----------- Capacity Disposal Field: Distance from nearest well W-40ffC,Distance from foundation___1L2___.___._-Distance to nearest lot line.,-�7-------- Number mber of Ii nes---3--------------------------Length of each ----------------Width of trench-,.2- X -------- Ty'e of filter material--)- k.2yeh ?f�filte� r�aierial-----lit-0"-_-Total length---- p -------------a- ----------tic, Seepage. Pit: Distance to nearest well----------------------Distance froth—founclatio'n--,—------------Distance to nearest lot line_____._.___-___- R ❑ ine----------------- 71 Number of pits----------------------- - Lining material-----------------a-----Size:- Diameter---------------__.-----Depth---_----------------------------- Cesspool: Distance from nearest well:____________.__Distance from foundation--------------------Lining material-------------- ----------------------- El Size.- Diameter----- --------------------------------Depth---------------;- ---------------------- ------Liquid Capacity---------------------- ---gals. )IJ Privy: Distance from nearest well----------------------------------------------1,-Disfance from nearest bu0cling------------------------------------------ 0� ❑ --Distance to nearest,lot-line-----------—----------------------------- ------------- Remodeling and/or repairing pairing [descri6e):----- --V- -----Col--s-1 - 1- ......... ----------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------- -- --------------------------------------- -----------------------•--------------------------------------- ---------- ---------I-------------I-------------------------------------------------------------7 _77------------------------------------------------------------------------------------------------------------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I+ereby certify that Fhave prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquiri Local Health District: (Signed)....../0 ------------------------------------------------------------------------------------(Owner and/or Contractor By:............. .....................................V---------------------------I-------------------------------------------------- Arifle)------------- ---------------------------------------------- (Plot plan, showing size of lot, location of system in relation- to wells, buildings, etc., can be'placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --------- ----- ----------------I-- ---------------------------------------- DATE-------. ------------- --------------------------------- REVIEWEDBY------------------------------- ---------------- ----- ----------------------------------------------------------------- DATE--- ----------- BUILDING PERMIT ISSUED----------------------- DATE------ ----- --------------- ----------- --------T,------------------------------------------ --I - --— ------------------------- a .Alterations nd/or recommendations;------------------------- --------------------_4-----------------------------------------I——......... -------!�-, ---------------=---------- i . r —I!. I ----------------------------------------------- --------- ------------- ----- ------- ----------------------------------------------------------------------------- ---------------------------------- ------ -------------------------------------------------- --------------------------------------- -----------------------------------------------I---------------------------------------------- .......... --------------------------------------------- ------------------------------------------------- ----------------------------------- -------- --------------------------------------------------------------------- ,q J ----------------------------- -------- -------------------------------------------------------- -•---------- ----- ----- FINAL INSPECTION-BY:---- - -- - - � D ----- -------------- - -- — ----------- - Vk SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South.Ainerican Street 300 West Oak Street 132 Sycamore Street C 814 North "C" Sireet Stockton, California Lodi, California # Manteca, California Tracy, California FS-9-2M Revised W-2100