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({�i 917��APPLICATION FOR SANITATION PERMIT Permit No. 9. (Complete in Duplicate) a Date Issued -_%X 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 AND LOCATION--------- .--." � e 7l- _2 "-� r -------- ---------------------------------------- Owner's Name y = l lil_5.+ =. 'O J ' _. -----------PW/`e4��--------------------- Phone--- r- Address i --•---------�Fp--f?---. z--•---- Contractor's Name -------•------ ---------------------------------------------- ______ ' ----- Installation will serve: Residence 21"'Aparfinenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I_____ Number of bedrooms k�____ Number of bafhsI�� -Lot size _ - �Q _r.__ A G)-�----------L -- Water Supply. Public system Community system ❑ Private ❑ -Depth to Water Table eft. Character of soil to a depth of 3'fee#: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑, Adobe[ ardpan [] Previous Application Made: Yes El No [ New Construcfion: Yes E] E]No TYPE OF INSTALLATION AND SPECIFICATIONS: p !®� � �� (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' SpWi c Ty kDistance from nearest well_______________Distance from foundation____________________Materia!_______.-___-____.___ - No. of compartments- -- ---Size--------------------------------Liquid depth-------------- -----------Capacity------- osal Fi IT Distance from nearest well-----------------Distance from foundation-------------------:Distance to nearest lot line___-.___..___.___ Number of lineS-A----------------___-_--------Length of each line___--------------- Yp T e of filter material----------- ---- ---------- -Width of trench_.---------•--------- - F_-- -�Depth of filter material---- -=---------Total length---------!-_-----------------_---_------ Seepage Pit: Disfance to nearest well.__f`{_ Distance fr m oundetion_ )i ' f �a-..........Distance to nearest'lof line___ ' `umber of pits__..-----------=--,___Lining maferial_ _ ____. De t' Size: Diameter__.-�'`-----_ -, p n ---------------- Cesspool: Disfance from `nearest weli_________ Disfance from foundation_______-_--________ lining material---------------------------------- F1 Size: Diameter `�1]epth-- e ^� ----- -------------- -------------Liquid Capacity--------- ---gals. Privy: Distance from nearest well______---______-_--- ��`-`----�---"'_-_•_:Distance from nearest building 9 -------------------- El Distance to nearest lot line ' � .� ------------------------ - Remodeling and/or repairing (descrie):_______ : I -------•----------------•--- --•---•------------•------•----•---------------------- f ------M_---------•-•-------------------------------------------------------------------------------- -------- ---------------------------------------------------------------------------------••-----•-------------------•------------------------------------------------ ----------------------- I hereb cer i of I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, \ate laws, d rule and,regul ions of the San oaquin Local Health District. (Signed)------------ elJ� [ _ . By:------------•----••-------------•-----•----------------------•----------- - --- (Title]- ' Contract -- - r or) g ' c (Plot plan, showing size of lot, iocation`of system in r tion to wells, b dings, etc.; can be placed on reverse side). FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY�_.____: DATE----------------------------------------------------- DATE-----��j REVIEWED BY -------------- -------------------------------------------------------------- BUILDING PERMIT ISSUED -----------------•--------- ------------------------•---- -------- DATE R,, A terations and/or recommendations__________________ -------------------------------- -- - ----------------------I-------------------------------------------------I------ --------------------------------------------------------------------------------------------------------------------------------------:-- ---•------••------- ------•- ---"---•-•----•-----------•------ ------------------------- --------------------- - FINAL INSPECTION S ----------•------------------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ! 300 Wes} Oak Street 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised W-2100 f