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APPLICATION FOR SANITATION PERMIT Permit No 3 1 (0 (Complete in Duplicate) / Date Issued .�[--i�5 -� r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordiinnnance No. 549, JOB ADDRESS AND LOCATION ' /-�� ----------------- Owner's Name------------- Qb- � f�- YG�f_� Qt'j------------------------------- Phone--- c,— zQ '---- Address =------------------------•- f�? -------------------- Contractor's Name---------------------------- > --�-� C�Py1--�-- �- - ------------- � cr------. ---- - ---- PhoneO� Installation will serve: Residence Pff Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L Number of bedrooms �_- Number of baths __I___ Lot size __ ---JC1f C> Water Supply: Public system X Community system ❑ Private ❑ Depth to Wafer Table { ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ Previous Application Made: Yes ❑ No 29 New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' N (No septic tank or cesspool Permi+ted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ C?/71;'_-Distance ,om f on4_______ Materia- -------------------�. cc No. of compartments---�--------------_--$--- _Liquid depfh_� ----- tJ, Disposal Field: Distance from nearest well Ck-s____Distance from foundation.—�_'_`______---Distance to nearest lot line-___1:0 -- ?� Number of lines______/__-_-________ Length of each line A "�W'a_��Width of trench___ Type of filter material__/,_ _;eV-��' ---Depth of filter material_1,-"------Total length__&_��'1P-&_ .. -' tSeepage Pit: Distance to nearest well_��-4.Y.-----Distant fr m f undativn__1�g "_____.Distance to near�est lot line__________ _ -- Number of pits---- Lining material _----Size: Diameter---- _ -at-------Depth-_ -------/-e Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________._________ ❑ Size: Diameter--------------------•-----------------Depth---------------------- Liquid Capacity gals. Privy: Distance from nearest well____-__ ____________________________-pistance from nearest building g ---------------. ❑ Distance to nearest lot line__________ ' Remodeling and/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 ordinances, State laws and rubs an egulations of the San Joaquin Local Health District. (Signed) L 9 ) n-C---------------------------------- Contractor) By:---------- -- Title --------------------------------------------------------------------------- - p* _____ (Plot plan, sho size of lo71t, locati of system in relation to wells, buildings, etc., can be placed own reverse side). FOR DEPARTMENT USE ONLY APPLICATION7ACCEPTED BY____ _.____--f________._ --------------------- ---------------------------------------- DATE REVIEWED BY- -------------- DATE--- ------------ -------------------------------- PERSSUED-------- ------ ------------ ----------- - ------- DATE------- -'�-------- - - --------------------------- terafions and/or recommendations______________________ FINAL INSPECTION BY:--- ------------------- Date-------- ----------- >6--- ec 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 8-51 Revised W-2100