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APPLICATION FOR SANITATION PERMIT Permit No. , `t_. r1l (Complete in Duplicate) 3,ty Date issued/Q_./.__._.._-- Y Applica+ion 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 Ordinance No. 549, JOB ADDRESS ANQ LOCATION------J-- _-�__-------------.�9------ - - - -----------------------------------------------------------------------•-- Owner's Name-----t-P"" _..... -------- -------------------••--------------------- -------------------------------------------- Phone-_-_----•--•------------------------ Address--------- ------Al`......1-112-10-1L.A,0__ -- •- -- ---•-•-----•---------------------------•-•--------------------------------- Contractor's Name-----1_3,x.----- P 0� ------------------------ -- Phon :.-__ 'nak21-( Installation will serve: Residence @!J—ftpar+ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I___ Number of bedrooms ---A Number of baths _/-___ Lot size .--Z4 r-_A_._/_d'a__-________________________ Water Supply: Public system A'Community system ❑ Private ❑ Depth to Water Table P—ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes L] No A—New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O Septic Tank: Distance from nearest weII T'%{___Distance from foundation---- Materal__ -------- ___________ __________________ . No. of compartments--------- —---------- - a- __. ----------Liquid depthYk.--------------Capacity__-.g_©-------- Disposal Field: Distance from nearest well-446s!--i—Distance from foundation----A—W-.-.---Distance to nearest lot line---/_4i__`_.__. [� Number of lines-------------- --------- _ Length of each line____ . �_ _ Width of trench..2. -*!____.__________.___ E Type of filter material__ -_-_ _Depth of filter material H _ -----Total length______��________________________.__ Seepage Pit: Distance to nearest well + ._—____Distance from foundation---Avg---------Distance to nearest lot line___4�-------- Number of pits._.____ ___Lining materia I__ s _.Size: Diameter_,?,3`0�---------Depth---:2r Cesspool: Distance from nearest well:---------------_Distance from foundation-___.---- ---------Lining material-_-_-___._________________________-_. ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals, Privy- Distance from nearest well _____-______________...._______-------------Distance from nearest building----------------------------------- _____. ❑ 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 rules and regulations of the San Joaquin Local Health District. , (Signed)----9*_�a----- ---------------- ----- {6wno�ajrJAgr Contractor) Title�y:....- f ) ------------------------- (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 APPLICATION ACCEPTED BY--------------------------------------------------------� ------------------------------ DATE-------- _10— REVIEWEDBY------------------------------------------------------ ---------------------------- ---------------------------------------- DATE---------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------- ------------ ------------------- -----------•---------- ---------------.---- ....------ - -------•----------------------- ----------------------------------•------------------------------------------------------------------------------------------------------------•-------------------------------------------- -------------------------------------------------------------------/----------- ---- --- ----------------------------------------------------...... ---------------------------------------------------------------------- :Y FINAL INSPECTION BY-- ------------------------ -----•--------------------------------�Wt date 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