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A��'< APPLICATION FOR SANITATION PERMIT Permit No. _ __4j_______ V �` (Complete in Duplicate) /� 4' Date Issued __!____3. _s:.t_ ' 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 Ordinance No. 549. JOB ADDRESS AND LOCATION----S.r -.as----r_0-----*V -4)ALpi-------------------------------------------------------------------------------------- ------------------Name ' A X11-� �Q ------------------------------------------- Phone_9--- -7, Address----------------S.Z.-9-'-------fF 0i----r �! /�R ----------------------------------------------------------- - :--------------------------------------------• --------------- Contractor's '----------------------------------------------------- Phone_7=_74� -7------- Installation will serve: Residence ®--'A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,!___ Number of bedrooms __.'_ Number of baths /_____ Lot sizeX__.lf� __/_______________________ Water Supply: Public system 2__�C_ommunity system ❑ Private ❑ Depth to Water Table -D_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L4--ilardpan ❑ 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.) M Septic rank: Distance from nearest well_________________Distance from foundation--------------------Material_____________________-_________________-____---- �Ci3Q/,V6 No. of compartments--------------------------Size--------------------------------Liuid depth--------------------------Caacit Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_______-_________ �) Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------- -------------- Type of filter material_________________________Depth of filter material-----------------------Total length__________________________________________ Seepage Pit: Distance to nearest well_ -0_V_ ____Distance from foundation-_047 ____.Distance to nearest lot�line-A7__________ Number of pits____I---------------Lining material_-L'_ !G_E"S______Size: Diameter---�c0__ ----------Depth__-___-_ r-_ ___________-____ Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material_______.__________________________--_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest bu;lding------------------------------------------ FDistance to nearest lot line------------------------------------------------------------------------- ------------------------------------------------------------------ E Remodeling and/or repairing (describe):------ _V_f'_P__t��_ ^�__! _`r! _ _ _!z _-_ro_pG� 0 _:�_U_m.P............... Csa�l1 _T_t2.d�2 ; ------C '_6�? -------K---R_.?!a-P----------------------------------------------------------------------------•------------------------------- •- ----------------------------------------------------------------------------------------------•------------,- -------- ----------------------------------------------------------------------------------------------------- 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 regulat�i✓ons of the San Joaquin Local Health District. (Signed)------ --------------------ra ---ON3� G' ----------------------------------------------------(Owner and/or Contractor) BY:--- fir.►'`? Q-'- --------------------------------------------------------(Title)---- ----------------- (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 REVIEWEDBY----------------------------- ----------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ --------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- --------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- - - "---��-�-� -``'u-�--------- Date----------�--- --�- - s - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100