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l rN' APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued pplica+ion 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. JOB ADDRESS AND LOCATION------ 1�� .........---------�_s�'�------------------------------- Owner's Name �7 /t iy ------. �-------- ---------------- ------------------------------------- Phone__-5 87 7--- Address-------- 1_u..... }. ------------ ---------------------------------- Contractor's Name--------IRA-----R ,6 ...... -- . ` ------•--------------------- Phone_,,,, .4/-.4-01' b .. Installation will serve: Residence Q�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l___ Number of bedrooms _.3_. Number of baths Z--- Lot size •__`-S7.�XIA_4- _______________________ Water Supply: Public system [4—Community system ❑ Private ❑ Depth to Water Table .Y•s'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe S--Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [!I-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic�T k: Distance from nearest well' Distance from foundation_ZQ.._.......Material..."--____- �. L3" No. of compartments..-----_.v2'------------Size_----•--_.XYO..•.___.---Liquid depth____Ve��-----------Capacity... _.._.. . Disposal +eld: Distance from nearest well -_Distance from foundation•__Ib__........Distance to nearest lot line___-__.3�_.... Number of lines___..,,__.____-_._�_ .________-Length of each line_/0d----------------_- of trench-----iZ_5!-___._________-_- �' Type of filter material.._S�J ack.__Depth of filter material ___��_��___...__Total length----- Seepag it: Distance to nearest well_� e" ---Distance from foundation___ 3v.�...._.Distance to nearest lot line----.5_...._.. Number of pits---- material.yKif_&!_&-Size: Diameter•___-_.`?�s�_'`__.___.Depth-__-_.�.s___�............... Cesspool: Distance from nearest well-----------_-----Distance from foundation-------------.------Lining material-------------------------------------- N ❑ Size: Diameter----- ------Depth---------------------------------------- ------Liquid Capacity--------....................gals. Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building---.-----------------..................... ❑ Distance to nearest lot line---------------------- ----------------------------------------------------------------------------------------------------------------------- Remodelingand/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 laws, and rules and regulations of the San Joaquin Local Health District. ��e o �8-�u c ev' (Signed)........ �__,Ver and/or Contractor) --------- ------- -- ----------- By--------------------- ----- ---Title --•••--- �= ( )• - (Plot plan, showing size of lot, location of system i elation to well's, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ r - =------------------------ DATE..U�.2-�7_ ------ ------------- REVIEWEDBY----------------------------------- --------------------------------- ......................... DATE............................................................ BUILDINGPERMIT ISSUED...................................................................................................... DATE------...................................................... Alterationsand/or recommendations............................................................................................................................................................... ................................................._........................................................................................................................................................................... ------------------------------------------------------•-----------------------------.--------------._......-------------------------------------------------------------------------------------------------------------•--- -----•--------------------------------------------•---•-_ ---------------------------------------------------------................................................................................................. ----------------------------------------------•-----------••---------•--------------------------------••------•-------••---•--...---•--...------------•-••---•-----------•---------•--•--•-•---•-•--•-•--•-•-----•---•-•----- FINAL INSPECTION BY:----------- ----------- Date �� 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