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5� APPLICATION FOR SANITATION PERMIT Permit No. ..3J!_!!._.__.__._ `' (Complete in Duplicate) `a Date IssuedVaqs/ ---^- �i Application is hereby made to the Sen 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. 0a— C�pQ —,36 6.5`f N'- ��'y- " ' D �-�L r ADDRESS AND IOCATION_QN I1-++ � *- OA �- _1- 1 1 / •� Owner's Name------•-/---`-' �l/-_4�..-------IF-1tf-,DL------ (-F Iylf ----Sp"VXLe_ Phone-------------------------------- Address -.!$.7 /1/ �lD� A--------------------------------------------------------------------•-- 47 Contractor's Name_,--.--------------- -1 .l. !T / r Phone -F 07------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®15f_1 Number of living units: Number of bedroomsNumber of baths ---_., Lot size -__ -.-rAC------------------------- Wafer ______________________Water Supply: Public system ❑ Community system ❑ Private X Depth f6-Water Table Z __ ft. Y5 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Vt Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ 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-_______________Distance from foundation--------------------Material------ ------------------------------------------ _._._____._________---------------____+ ❑ No. of,compartments--y----------------- Size---------------------------- ---Liquid depth--------------------._ Capacity---------------- -- --- Disposal Distance from foundation__�S_.__:_-...Distance to nearest lot [line_- ------------ Number ___.___ Dis asal Field: Distance from nearest well � �� I p Number of iines_____� -----------------Length of each line_____�Q___. ___-_-.-_ Width of trench.. _ ___._______._______ Type of filter material%_Aocx-----Depth of filter material---I_9--...-__--_-Total length_ � �_�_______________________ Seepage Pit: Distance to nearest well----------- ---------Distance from foundation-------....--------.Distance to nearest lot line_______________ El. Number of pits------ ---------------Lining material-----------------------Size: Diameter------------- - -------.Depth----------- ------------------ N Cessp",I: Distance from nearest well__._____________Distance from foundation____________________Lining material____-------------_----------------� ❑ Size: Diameter--------------------------------- ----Depth--`---------------------- Liquid Capacity------------------ ---------gals. Privy:` Distance from nearest well------------------------------------",- --Distance from nearest building-_f__._.____________________-----------. ❑ Distance to nearest lot line------------------------- ----------- --=-----------------------------=------------------------------------------------------------------ Remodeling and/or repairing (describe):_..-___-- ` -. ' -------------------------------------------------- s-- -----------------------•---------------•-----------• ------•-- ------------ ------------------------ •---------------------- ------------------------ - --------------------------•------------------- -------•------------------------------------------------------------------ - ------------------------------------------------- y r I hereby certify tha have prepared this application and that the work will-be done in accordance with San Joa uin Count ordinances, State law , and rules and regul ,dons of the San Joaquin Local Health District. -= (Owner an /or Contractor) (Signed)--------------- -----� - - . --------- - ------ -- r g • I _ CSC ek-��- -----------(T=le � � Y- (Title - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placeon reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTEDBY------------- -- - ---- -------- ---------------------------------------------------------- DATE------G--- -�i-- --- -- ----------- REVIEWED BY ------------ ------ -------------- ---------------------------------------- --- -- - -- ------------------------------------------------------------------ DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ -----------------------,------ A Iter tions and/ acorn en 3tions:- ojtr --- , ------------------------------------------------------------ --- ------- ''� ------------- ------- ----------------------------------------------------• -• AA°` !--------------- -------- ----------------------------------------- -- ----------------------------------------------------------------------------------------------------------- ------------------------------------------- --------------------- FINAL INSPECTION BY------------ =' -- ..-------------- Date......: '- - - -'- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California • Tracy, California ES-9-2M 10-52 Revised W-2100