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r 91 APPLICATION FOR SANITATION PERMIT f Permit No. ..... (Complete in Duplicate) �Com p ��'''' �� Date Issued A lira{ion is hereby made to the San Joaquin Local Health District for permit to con�tructlnd install the work herein described. PP Y q This application is made in compliance with County Ordinance No. 549. �q 7`� JOB ADDRESS AND LOCATION------ i 8 /� /- -e%_------------- ------------ ----�d------------------------------------I Owner's Name ra-,n_.� -- '�. 4�C ------ f0-f---------- -------------------------------------------- Phone 4- _X_7/ �j -------- Address--- -21 ------ ------._.... Contractor's Name. ... eZ ' Phone ---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I--- Number of bedrooms Number of baths I___ Lot size !oQ ----Lc3�------------____________ Water Supply: Public system ar-c—ommunity system ❑ Private ❑ Depth to Water Table y�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er-H—ardpan ❑ Previous Application Made: Yes ❑ No [R�JNew Construction: Yes'[+rlo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) led Septic Ta Distance from nearest well_______.__-_-.Distance from found'anon-__-f- :.______- ateri L__r________________________________ •---- No. of compartments_---- -Pte---------------- depth--- --- ------------Capacity---�'� -- -- rr��,,� D Disposal -field: Distance from nearest well___/1.�.r_Distance from foundation___f____---------Distance to nearest lot line--�_______J`_�._ .� Number of lines------__/______�___--®-__Length of each line7__�'�---.�__ --- Width of trench------ __ __-------------- Type ___ _________Type or filter material--�.2!.-._QTaG._Depth of filter mate'rial____�>e._____Total length---- -r____________________ 610, Seepag10 e Distance to nearest well_:;� ----Distance rom fou dation--__e7_-'5_ to nearest lot line---�S______ Number of pits._._I--:-----------Lining material________________ Size: Diameter______.3�__�-_ Depth____ _s�_______-_- --- Cesspool: Distance from nearest well--------.----_---Distance from foundation ___-_---_---- Lining materia!_____________________________________ ❑ Size: Diameter--------- -------- ----------- -------Depth---------------------------------------------------Liquid Capacity- --------------------------gals. O Privy: Distance from nearest well------------------------------------_--------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line =--------- -------------- ---------------------------------------------- _ F. Remodeling and/or repairing (describe): ----•--•-------------------------------•-------------------------------------------------------- -- - - - ------ . r M - . .. --------------------------------------•-----------------------------------------------------------------=--------------------------••------------- ------------------------------------------------------------------------ I ------------------------------------------------------------------------------------------•------=--------------------------------•-------------------------------•---------•------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- -------�--7--- '� ( wner and/or Contractor) B Qrv�.i - (Plot (Title}- - - - -------- ----------- plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY___-- -- [� '� "►r _- DATE--- REVIEWEDBY------------------------------------------------------------- -- ------------ ----- --------------------------- DATE----------------•- BUILDING PERMIT ISSUED------------------------------------------------- --------------------------------- ------------ DATE--------------------------- Alterationsand/or recommendations--- --------------- ---------------------------------------------------------------------------•-•----------•-------------- ----------------------------------- --------------------------------------------------------------------------- --------------------------•-------------------------------------------------------•----------•--------------- ----------------------•------------ -------------------------------------------------------•------- ---- --------------------------------------------------------------------- ------ •--•----------••--•---- - - FINAL INSPECTION BY-----------------------ll � �!/�G --------- Date---- - - ---• r/Z v, - - - -------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100 10/010