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APPLICATION FOR SANITATION PERMIT Permit Na,?_3 "" ."r.__ i (Complete in Duplicate) Date Issued ----- F Applicaa•ion,is hereby made to the San Joaquin Local Health District foraermit t 7 This application is made incompliance with,County Ordinance No. 549, p ° construct and install the work herein described. JOB ADDRESS AND i LOCATION-.' Owners Name--------- _-_-_r- t-•-i-•---------•------------------- ---:•-------------------- -•------------•------"--"-- ti �7 ---------------------------- -- Address am -- - --- -- Phone---- ---.---aC.-----•------. 2-. Q � -------•--•----------- Contractor's Name-------Ae1-tc7_ k ' Phone----- Installation will serve: Residence E`: Apartment House 0 Commercial ❑ Trailer Court ❑ _Motel ❑ Other ❑ f Number of living units: __1____Number of bedrooms ._2_.. Number of�baths - 1 Lot size - �Q--X -50---------- Wafer Supply: Public system -` +• ' ------•------•------.- + Y [2 Community system ❑ Private ❑ Depth to Water Table __40 ff. 1 Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay p Adobe ® Hardpan [] Previous Application Made: Yes ❑. No ® �New Consfructio' 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_.__ ,1v L0--r----•--.Material I------ _ez.etl_t_--------------------- No. of compartments_.--------2-------------Size---- __'_x4_!x _! .__•Liquid de th.__ 'Ry_ ' } q P3 '� __--Capacity_8QQ------------- Disposal f=ield: Distance from nearest well._.50------_Distance from foundation-----10-.' _.Distance to nearest lot line.___."�""___.__ I ' r - [2 Number of lines----1---------------------------Length of each line------1,Q ----_--:-""--'-.Width of french P__1 Type of.filter material-__r";7 ,-"_- "Depth of filter material-____18" Tota) length-----------------0' _ Seepage Pit: Distance to nearest weltst-,f}' -___Distance from foundation-----LQ_1:_..... Distance to nearest lot line-_ ,. i p g r Number of its__-1---_---".--""--_Linin material___-_rQG1 _____.Size: Diameter____ Q-_ -------- Cesspool: Depth--------3Q................... ❑P Distance from nearest wefl ______Distance from foundation------------ material_-._.-__._____--__."_.__ _ Size: Diameter------: --- - _ - --- --- --- --- ---Depth----------------------------- --- Priv r 11Distance from --- Licluid Capacity-------------------------- -gals, Y: - Distance from nearest well----------------------------------------------- R nearest building �1 Distance to nearest lot line 9 --------------•--- ------------ -----------------------------------•--------------------------------- -- - --- emodeling and/or re iring (describe):--" S-- .i1IQ1 bed�3--------------------------/ L D -em ��i i._�.Q.-Wit•----3,.e�_Q.b.. ani.---3Q....�-•30•'. _fit ter ; 's�S ..__r. .r ________________________"_.-_-_-__-____"____-__---__.___.-__--_______,-_______________..- __________________________"_._____-____________.____.____--______.___--_____-_______..____-__..______-________-________---____-___.-___.___.____•"-__--____.________.-_____.._______.-.______-_-_____.--_-______--__- 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 Districf. (Signed)---------------------------- -----------------D-e-1t,a_,---. r . - -----------------------------------------------------------(Owner and/or Contract By----------------••--------Pnrryr---Ua_r-than------ -v ------------------------------------------------( Title Ge .._Tki; or) - r (Plot plan, showing size of lot. location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWEDBY _ ----------------------------------------------- DATE--------- - .......... rte” -�'- BUILDING PERMIT ISSUED - = DATE ---- '• ` of ,,� ___ _ �.,. ----- -------------------------------------------------- DATE Alterafions and/or recommendafions:. __.__-_ w ------------------------ --------- ----------------•--------•-- ---- --------------------------- -------- -------------------------------- - -------------•-------------- -------•------------------------ a i FINAL INSPECTION By:.. -� ._..�,,$" ...................... 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