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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ✓ - Date Issued A, lica}ion is-hereby made to the San'Joaquin Local Health District for a permit to const uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION ---�---7---- R�_�------- .....0- _i-�0 .----••----------------------- -•--- Owner's Name------------ _7r---------LYf . v _�' _= ------'----- ------------------- Phone__ � Address __ ---------------�Y/r� ------------- •----------------- = -- �•,��7------------------ ----- -- - Contractor's Name...... f_ C/ 2.L -------- Ls d! '--------------------------------=------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 I Number of living units: _ .____ Number of bedrooms ..Number of baths J--- Lot size __ _ '__ __f ----------------`--_-_---_ Water Supply: PublicsystemR"'Community system ❑ Private ❑ Depth to Water Table..1j�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No 2�. ' New Construction: Yes ❑ No [A TYPE OF INSTALLATION AND-SPECIFICATIONS: °. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .. 1 r r �,,.y,,,,,.,•. ....�rL....�i.e'l�-}.� ..: .i..wxw.h z.._- w -. .�. s: y .r,- Septic Ta' t�nce from nearest well-----------------Distance from foundation-------------------.Material----------------------------------------------- ,..,F�: ❑ N of compartments.----f__T"'-------------Size...................:.E_....:---Liquid depth___.......___........Capacity.......-.---,---.-----. ❑ ala d. " ` -`------ ---- g f ...... -- -.--_----Distance to nearest lot line----------------- Disposal Fi N�nan of from well________-•--- -Lesna+h of from line ation__..____. . . G 1-i " ; _ -----._.._.Width of french.---------------------------------- filter material-Type os -----'--------------IDepth of filter material'-;--------------_---Total length-:-_----------------------------------_-_- [ Number of pits.- ��--'Disf.ance from f un[)ation__--rge'-.-.:Distanc� to nearest lot line-----�_---• 1 71 a �" r 1 Seepage Pit: Nu`mbee to nearest ell___-- Lining material. C e—_j c�tize: Diameter--- _5.__...._.Depth_-- �___ _____________ Cessp, Size: D amrom' --------------------------------------s - Distance from foundation �- .Lining material-------------------------------------. ❑ool: Distance from Heast well-------- -Depth----------------------------- -._ - .....Lining Capacity----------------------------gals. f n Privy: Distance from nearest well--------------------------------------------------Disfance from .nearesr building-_---_-__-------------________'____---._. V' «. r �. -- - - � . .J. 3 El Distance to nearest at�line-----------------•----------=--�'.-"--------------------=---------- -.----------:__-------------------•------------=---------------------- -------------------------- Remodeling ---•--------------- Remodeling and/or repairing (describe):_.__- b -- ._-__ -_._-_ -__-----_.----.-,.____ y _____ + ..... ------- --------------------- ---------- ------------------- ---------- --------- -- ----- ----------------• -------•--------;-- ------=------ ---------•--•---•-----•--_---- •------------ ---- ------------------------ --•--------------------- ----------- ---- ------ -s�----------------•--------•-----------------------------•--------- ------------------------.-_-............----••- ----- - -------- --- ------------•--------------------------------------- L - _____ ______________________________ _________ ___ T anances, Stpare a s, and rules and regulations of +he San Joaquin Local Health District. I hereby certify that I have prepared this application and that-Ae work will be done in accordance with San Joaquin County ord' � y (Signed)........ R -- ---- --------------- -------------------------------------------w - � ------{Owner and/or Contractor) Plot pian,-_showin s��of lot, I��oc ion of system in tion to wells; buildings, etc.,------'[r+le]______________ ____ ______r-.-_.___.._..-..___........-..__ ( p gg can be'placed on reverse side). FOR DEPARTMENT USE ONLY 1 ,r 4 . --* APPLICATION ACCEPTED $Y------------------------------------------------------I - ----------------•------•---------------- DATE------'`---......----- •-� REVIEWED BY- ----------------------------------- -------------- ---- - �. ---------- I �.,, �------------ ------- ----� �--= -�---- :- -------------------- --------- DATE_ --- --- �- •---:-- BUlLDlNGPERMIT ISSUED--------------------------------- :�..�-�-°.-----•------------------`--=--=----==--------- DATE.�---------•---J------------•------------------ Alterations.and/or recommendations:--------- ---r - t r i ...r, s --------• --------------------------------------------- ------------------•--•-----••--------- ----------------------------•---- -----------------------------------------------=-------------------------...............,.--------------.-------------------------------------- ----------------------- I § 5 . ----•-•-•-----•---•------ --- ----------------------•--•------------------ .......---------------------------------------------------------------------------- .............. ------------------------------ .3 FINAL INSPECTION BY:__-✓� _�- ------ ------ ''`. _Date:_:: ` ------- ------ ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r, Stockton, California Lodi, California Manteca, California Tracy, California r ES-9-2M Revised W-2100 r1