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;F ( APPLICATION FOR SANITATION PERMIT Permit N '- _---- S )j-6 {Complete in Duplicate �/�/ • 1 Date Issued -'�`-_! Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal(the work herein described. This application is made in compliance with County Ordinance No. 549. F JOB ADDRESS AND LOCATION----14�L....5,,uaj-n----fi-o?"" ---------- Owner s Name.. �' - h-- ------------ ---Phone_- T_W7-� ---•---��Address_...........------- -----`5��ah Q-d�-s -•• Contractor's Name------------------------- --------------------------- --------------------------------- ----------------------------: Phone-- Installation will serve: Residence [ Apartment House Commercial [-] Trailer Court ❑ Motel E3 Other [� Number of living units: __1---- Number of bedrooms ----I--- Number of baths ----- Lot Lot size .--_-l-z ~_---- --- ___---------------- Water. Supply: Public system-V_ Community system ❑ Private K Depth to Water Table -------- ft.-- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [K Clay.❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No,K New Construction. Yes' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -' Sept Tank: Distance from nearest welw �------ izeanc ,foundation quid d pth---Material _--'- Capacity____ No. o£ com artments-..._ -� - I r i l Dispos�ield: Distance from nearest well-.Ft;y LyT_Distance from foundation./ _Distance to nearest lot line--- Number of lines f-----•I-------------------------Length of each line------- ----_-.-- Width of trench------- � --' -------------- f W -. LL Type of filter mater.ial.�.-r-R�1L__Depth of filter material---1- ----------------Total length--------R-0-----------__-___-_-.-.-. Seepage Pit: Distance to nearest well---------------------- from foundation----------------.-..Distance to nearest lot line-----.-'-_._----_ ❑ Number of pits.-1-------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- S 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----------------------------------._-_____ �r ❑ Distance to nearest lot line------------------------------------ '9 Remodeling and/or repairing (describe)-----------------------------------------------------------.------------------------------------------------------__1------------------ ------------------------------------------------- ------------•--•--•---•-----------------------------------•---------------------•-------------•-------------------------------------------------------------------- I I k ----------------------------------------------------------------------------------------------------------------•------------------------------------•--------------------'--------------------------------------------------- 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 rulesandregulations of the San Joaquin Local Health District. .. (Signed) / I-1_-I-'- - ------------ - - --------- ---'---'------ ------------------------------- --- --'-------------------------- - - --{Owner and/or Contractor) By:--------------------•.----------------------i------------------------ -------------------------------------- •-------------------(Title)--------•------------------------- -----' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- .- •--- �- - Wit* = .-._ DATE ... k� --- ----------------------- REVIEWED BY-------------------------------------------' DATE BUILDING PERMIT ISSUED------------------ --------•-------------------=-------------------------- -------------------------- DATE AIt roti ns and/or recommendations: ----------•---- ..1 ... d serf- �` X11 - s - ----••------- ---------------------------- ------- ---------- ' - --------------------------------------------------------------------------- -------- ----------------------------=---------------------------------------------------------------------------------- - ---------------------------------------------- -------------------------------------- FINAL INSPECTION BY--- -------------- s Date ! w SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California }r Lodi, California Manteca, California Tracy, California ^� ES--9-2M Revised W-2100