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APPLICATION FOR SANITATION PERMIT Permit No. ..G�- .. ... (Complete in Duplicate) Date Issued 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. D �,p� r , JOB ADDRESS AND LOCATION_: Owner's Name-----4�1d.?ITA-- tPhoneK- 4 7 ,- ------------------------------------------ --- ------------------------------------- -----------................ -•---•---- L(Z ,A � p- O Z�-060 — ddress � pc.__ Z ------------------------••-----------•--•------•---------. Contractor's 71�w CC=--------------------------------------- Phone------F7;- - ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __------ Number of bedrooms _3__._ Number of baths -1----- Lot size ------IJ,3_!_?K_--24D_.__-/__._••._••---------- 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 [2'--.Cla Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0"' New Construction: Yes ❑ No [J i 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----.�d'�_Y'__-_Distance from foundation---------- ..-......Material_________________._ ----------------------------- ❑ No. of compartments--------------------------Size----------------------------:---Liquid depth--------------------------Capacity----------------------- Disposa Field: Distance from nearest well_____9-4._Distance from foundation--------------------Distance to nearest lot line-----e-------- Number -_____Number of lines-------------/-_--------------- ---Length of each line------la- �-�-----_._.Width of trench-.----- --------------- Type of filter material 6rG ' Depth of filter material______l_6r.________Total length------ _4a----__________________ Seepage Pit: Distance to nearest'well____ 7._._._______Distance from foundation___________________.Distance to nearest lot line____-.__________- � ❑ - 'Number of pits----= ----------------Lining material-----------------I---..Size: Diameter-------------- --------Depth--------------------------------• W Cesspool: Distance from nearest well-----------------Distance from foundation-----_------------ Lining - = - -..: - material_-_--__._____..____._______._--___-_ .—❑. . Size: Diameter_, - y--=-- - --------------- -- ' Liquid Capacity =- _ gals. ; Privy: Distance from nearest well------_,___-------------------_-----------------Distance from nearest building_------__.__._____________-___•--- ❑ Distance to nearest,lot line -------------------I--------------------------------------------------'----------------- Remodeling and/or repairing (describe):---'-- �C.7�lsawrL' -�7---- _!_. !-rt�-----6"'d-!!T-•----------•--•-•------•---------------•-- V s ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-------••-•---------------------------- --------------------------------------------------------------------------------------------------------------------------'------------------------------------------------------ ----------------------------- 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 District. (Signed) �-------- --s- - i�-- ©----------------- ----- ,� tractor) By.--- ---------------(Title)_/074/ i S_e �%'�& t'• (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 APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE------------------------------ ------------------------------ REVIEWEDBY_------------------------ -------------- _ ------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-_----------------- ------------------------------------------------------------------------------- DATE---------------------------------------------------- Alterations and/or.recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------•-••--•----------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ------------ ------- ---- ---- ---------- --- ------------ --------- •------------ ------------------------,--------- ---------------------- ---------------------------- FINAL INSPECTION B - ---- ----------------------------------------------- Date_____ _ _____________ SAN JOAQUIN LOCAL ALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M Revised W-2100