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1 c' � 3 � APPLICATION FOR SANITATION PERMIT Permit No. ................. ...... 1 ►, - 11b [Complete in Duplicate) Date Issued - Health District for permit to construct and install the work herein described. Appl�ca}Eon is hereby made to the San Joaquin Local Hea This application is made in compliance with Count Ordinance fNo. 549. 3pv 1,� - V G - , JOB ADDRESS AND LOC . ._.! - _ .. C� e d-Is-----------hf- 8-�----------- r' Name_. 12f LGA-L.. i _Al. l 1� --------------------- - - - ----- Owne s e / Address. 3 ��-----� _�/t?..o r ------- ........... C / P ° Contractor's Name-------------•------------• -- ------------------------------------------- ---------------- Phone------ -----------•---------------- Installation will serve: Residence Dj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- __.l_. Number of bedrooms _-Z._ Number of baths ---L Lot size .___. ----A-er.$--------------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table17._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0,- Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes DS No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-__-f? _�--Distance from foundation--- __�_.---Material..-... k+- --dT--------. f� ❑ No. of compartments------..-_-......--___Size--_._�--x_�--X--'5-----Liquid s�^^depth_-._----- -"-_..--..- Capacity.-.._ SL _ 1 {� Disposal Field: Distance from nearest well----�Q� _-__Distance from foundation.__-�vr---------Distance to nearest lot line-------ir.�... p Number of lines--------------'11----------------- --Length of each line---------00-+;---------Width of trench---..---)- -------------------- ❑ Type of filter material..--I1,1y----------------Depth of filter material.--..--j`-...._____.Total length-_-____-..1 49...------___-_...._____ Seepage Pit: Distance to nearest well------------- --------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----.----------------.---------- v Cesspool: Distance from nearest well..............__Distance from foundation-------------------.Lining material--_...._-_.._______.....__--------. S ❑ Size: Diameter--------------------------- ----Depth------ ----------------------- ---------------------Liquid Capacity--------------------- ------gals. Privy: Distance from nearest well------------- -----------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line.-------- -=--------------------------------- ------------------------- --------------------------------------------------------------------- - 1p . 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 D ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, O r f {Signed}. --- -----------------------------------------------------------------------(Owner and/or Contractor)i .,JCSC.�. rs►t�t, By:-------------------------------------------------------------------------------------- --------------------------------------------(Title)--------------------------------------------------•------------- (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 ---------- DATE --- - I APPLICATION ACCEPTED BY----------------------------------- ------------ J� �-- -------------- ------------------------- DATE- ---------- -- -- --- REVIEWED BY-------------------------------- ----------------------- - ------ -----Pr BUILDING PERMIT ISSUED------------------------------------------ ------ ---- -------------- DATE . 00 Alterationsand/or recommendations--- ------------------ ---- ----------------------------------------------------------------•----------------------------------------•------- -----------------------------------�f 3-------------- * "-----+il-f-----V--�---�G�[ �j�, f�-----------------------•-•-•---•--------------•------ --------------------------------- ---------------------•--------------------------------------------- -------- -------------------------- ---------- ------------------------------------------------•---------------------- ------------------------------------------------- ----------------------- ------- ------�---------------------------------------------- -------------------------------------•--J----------------------------. . (/. i�/� Cy 'r`!f`/-------- Date � �N �1 �C-` FINAL INSPECTION BY:.--------- �' �---------------------- 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