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If woe-,-- APPLICATION FOR SANITATION PERMIT Permit No. ._ t __�� (Complete in Duplicate) Date Issued � �- ` la W t 33—olva- 0l 5 -- 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 complian ith County Ordinance No. 5499.. JOB ADDRESSMD LOCATI4 ------------------ O N- - t l e-------- ------- P-------i-- • Owner's Name - �'�j`�---- �4-._ _ t - Phone - Address-------------__---- -- `-- ----- -o�t S'__d l � -------------------------------------------------------------------------- Contractor's Name_.. .-... an�u..- ------------------------------- --------------------------••---------------------- Phone----�_ gp4�d Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑- ^�.� Number of living units: ________ Number of bedrooms ________ Number of baths -------- Lot size )__ _}�._G14.--2J..-_-'_______._._��___¢¢__"__��_____._ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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_A-D_--__._____.Material____— No. of compartments---,Z----------------- � �� __.Liquid depth___�1-�r_______Capacity__/?9-!? eA_O Disposal F, Id: Distance from nearest well-. +�- - Distance from foundation---1_�-______.Distance to nearest lot line. ��_r� Z E Number of lines----I-_________I_ �_�__ __ _ Length of each line__/_«Q__!_-----------Width of trench._ "__________________ Type or filter materiaLl_�__0�.___Depth of filter material_____Z.7------_--Total length-----1sP_Q_'___________________ Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot line--_-_-_-_---_____ ❑ Number of pits.--.------------------Lining material-----------------------Size: Diameter--------------.--------Depth--------------------------------- Cesspool: Distance from nearest well-_:--------------Distance from foundation----------------..- Lining material------._____------------_---_____-__- ❑ Size: Diameter------ ------------------------------Depth------------------ ---------------------------------Liquid Capacity---.------------------------gals. �l Privy: Disfance from nearest well ____-____________________----------------------Distance from nearest building--------____--___-___________.____---.-. ❑ Distance to nearest lot line----------------------------------------------- --------------------------------------------------------f------------------------------------ Remodeling and/or repairing (describe:_ __T► ______ is x_ --------e_^tet- -_ -- _. ___! _ler-Q+--e- _. Ir� - ----------` , - ,-_-'_ -� —-------------------------------------•--•----------------•--------------------------- ----------•-----------------------------------------------------------•----------------------•---------------••-----------------------•----•---------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat nd rules and regulS\ns of the San Joaquin Local Health District. (Signed)-------------- --- --------- -------�`---------- ------- u�sn.ae>il+Ler Contractor} - ------------------------------ gy:------------------------------------------------------------------------------ = 1�-_ " (Tit€e} � �f x�tl� ...---------------- (Plot plan, showing size of lot, location of system in rela+i n to wells, buildings; etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BYO ---------- ------------ � ------------------------------------••----------------------- DATE- ---------•-------- REVIEWEDBY---------------------------- - ---------------------------------------- ------------------------------------ DATE----5 -----------.------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..-----qM Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------ ----------------------------------- ---------------------------•-•---------------------------------------•--------------------------•-----------------------------------•----------------------------------...-------------------------------------------•----- ------------------•---------------•----------•------------------------------------------------------------------ ----------------------------------------•---------------------------------------------------.•-------------- ---------------------------------------- -- ----------------------- -----•-- --------------------------------------••-----------------------------------------------------------------•---------------------------------------- FINAL INSPECTION BY:..----W l '."'--------------------•----------•----- Date----- ------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Straet 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revised W-2100