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: i Permit {lo: ... APPLICATION FOR SANITATION PERMIT ...-..._ (Complete in Duplicate) 1 .---�— 371'9 Date Issued .-- - Application is hereby made to the San Joaquin Local Health District for a permit to constructandinstall the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND LOCATION-----------------�a4 J--------�----------------�- � --------------------------------------------------------------------�•- ----------- 7feOwner's Name-----------------------10,s-x.--....x-A_m-PUA-------------Ohl_-F5 ---- ----------------- Phone-------------•--------- ----------------------- ------- Address-----------•-----• "- -------------------- � ` ---------------------------------------------------•-----.------------------------------ Contractor's Name---------------------------------------------------- -------------------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Living units: _______ Number of bedrooms ___A_ Number of baths ___I___ Lot size ---------49p4---- _17,�_____________________ Water Supply: Public system JV Community system ❑ Private ❑ Depth to Water Table ____�_ ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yesv No ❑ New Construction: 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--------I-b---Distance from foundation------/D_--------Material________ -1-Al'_______ (9[ No. of compartments----------�k------------Size�A)4A-__K-_________._..Liquid depth_______�Q-------------Capacity____.. ��f_-- Disposal Field: Distance from nearest well-------1�4____-Distance from foundation-----1�_ _-------Distance to nearest lot line._____��_______.__ ' ] J7, Number of lines_____._____.__ - ________!-_-_Length of each line--------1_00__14__-_Width of trench_______' �----1_2�0____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------ - ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------------_- 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-----------------------------......... ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)_____----------------------------------------------- -.----- ------- - - --------- ------------------------------------ --------------------------------------------------•---------.--------------•-----•--------•---------------------------------------------------------.----------------------------------------------------------------------- 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) _______________________(Owner and/or Contractor} By:------------------------------------------------------------------------------------------------------------------------------------(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------------- - ---------------------------------------------------- ------------------------ �l ------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---- Alteratio s and/or rec_ommendatlons----- --------------------•-------- : r----------------•--------------- -------------------- I I -------------- �Iy s I / , I L=4 C /� �`G � {1H-f r; YYr��rcrt air w ------ ----------- - ------------------------------------------------------------------------ -- -------------------------------------------------------------------------------- -------•---- -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINALINSPECTION BY------------ ------------------;-------------------------------- Date---------------•---------- ------- -------------------------------------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT _ r 130 South American Street 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