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APPLICATION FOR SANITATION PERMIT Permit No. d....._.... �"'t 1 (Complete in"Duplicate) l w 6 Date Issued __!1__.- ,5.3 yr wo h rein described. . i trio for ermit to construct and install the rk e Application is hereby made to the San Joaquin Local Health D s p This application is made in compliance with County Ordin ce No. 549, JOB ADDRESS AND LOCATION.... .......L19.1ev - - -------r---------------------------------------------------------------------------- t Owner's Name- --------- -= -- ------ -- ---- ------ ._ - - ----s ------ - --- - ------ hone------------------------------------ Address-------•--------- ---- z-•- -- -- - --- —---- ---- ----- - - ----- -- ----------- - -----------_--------------- -- Contractor's Na a----- -4-wr--- ------4120 - - Phone--:., - Installation will serve: Residence Apartment House [_1Commercial EO] Trailer Court E] Motel ❑ Other 3 i Number of living units: NuIm1:5er of bedrooms 2--- Number of baths -_f___ Lot size _ __ ! _ __________.___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Na ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewgr is available within 200 feet.) Septic Ta Distance from nearest well/_f/ -lN istance from foundation___!__---------Materi I___4A No. of compartments-- Si _--Liquid depth--- / Capacity .� _ � - W Disposal Fi Distance from nearest well_A/90V istance from foundatio �Q______._.Distance to nearest lot line__�0-___._ ❑ Number of lines-----, __: .__ ____Length of each line_____ _� Width of trench_.___ Type of filter material-'_�tx. _.__Depth of filter material ._/1---_._____Total length______________.___-� ____________. Seepage Pit: Distance to nearest.well----------------------Distance from foundation---------------------Distance to nearest lot line_________________ ❑ Number of pits----- ----------------Lining material--------------------- Size: Diameter------------------------Depth------ -------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_ _---_-_____.____.__.__.__._-. ❑ - Size: Diameter----- i--=----------------_-- --_::_Depth_- - = -------=-----Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building_,_______._.___--_---------------------. ❑ Distance to nearest lot line---------------------------• ------- G��------------ - ------------------------ --- ---------------------- Remodeling and/or repairing (describer---------------� - -- - - --- -----•----•--- - ---- - ---------- -- -�---- - -------- --- ------------------- -------------------------------------I------------------------------- -------------•------------------------•----------------------------•-- --- - ---- --------*----------------------------•------- -------------- ------------- --- ------ - -- ---- , -r" ----------------------- ------------- - ----------------------------------._..._.------------- ------ -------`--•--•---pp-----------------•,1 q�.--------------------------------- --.------------------_------•,-------•--------------.---------------- I herebycertifythat I have re ared this application andthat the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and re lations of the San Joa in Local Health District. �- - ----- ------- - P _(Own 4 an d/or Ccftractor)Si - - (Title) =By= - ------ - Ze-& --------------------------------------- (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------------- = -------- -------------------------------- DATE-------------.../_ . :. 9l {'�` REVIEWED BY--------------------------- --------------------------------- ---------------------------------------= ----- DATE--------z`----------------------------------- ----C�• ------`-'----- --------------- BUILDINGPERMIT ISSUED----------•--.------"------------------------------------------------------------------------------ - DATE------------------------------------------------------------- Alterations and/or recommendations:----------------- ----------_---• ---------- _.-.-------------------•-•------------------•- "----'------`---------•----------------•--•--------- ---------------------------------------------------•------------------------------------ --------------•------•-•--------••----------------------..------------------------------------------------------------------------- ------------------------------------------------------------------•-------------------------------•-----------------•-------------------------------------------------------------------------------------------------------- iI ---------------•----------------------------- -•---•----------------- ------------------------- ---------------------------------------------------R ----------------------------------------------------------------- --------------------------- ------------------------------------ --------- ------------------------------------- FINAL INSPECTION BY:.-- ----------------- Date -----------�/------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT - I 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 I0-52 Revised W-2100