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ie APPLICATION FOR SANITATION PERMIT Permit No•al--r `S` ---- --_ (Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct adz;a �w]or rein dgscrid F This application is made in compliance with County Ordinance No. 549. " JOB ADDRESS AND LOCATONwO.171o� S--S6� _d �__,- ------ ----- - 1 / il�_7hrt. -. ------------- --------- ----- Phone I Owner's Name _.4-1/l.-I Q Q - _ ---- ---- - ' p �} " •- --------------------••-•--------�---------------------•----------- --------------- ----- Address. Phone 4- Contractor's Name----- -�------�w�--`�-�'----------•----•------_#------------------------------------------•-----------------�----------------- ••------- t $ Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: IlResidence �, �partment House ❑ ❑ f I Number of living units: __�-__- Number of bedrooms .3--- Number of baths -_�----- Lot-size ..-_--,.1__-��`-'e------- F Waterl Supply: "Public,isystem '❑ Community system [I Private J Depth'to Water Table -------- ft. Character of soil to a depth of 3 feet: �Sand ❑ Gravel El Sandy Loam El Clay Loam E] Clay ❑ Adobe Hardpan E] 11 Previous Application Made: Yes ElNo,� New Construction: Yes JK No E] y F TYPE OF INSTALLATION AND SPECIFICATIONS: ' 1 No septic tank or cesspool permitted if public sewer is available within'200 feet.) ( ! p t" __ �, . .,�. Tank: Distance from nearest well-�.-'!�--Distanc from foundation-��!" �----. -_}'! ___ --- Septic , No. of compartments----__ - :Size--- ,�. 3---•--•Liquid depth-------��-�"-----------Capauty._-- \ Disposal Field: Distance from neares well�0_Hljf?"_Distance from foundation--JO�rn�r�---Distance to nearest lot line_--._ --.�----- Len Length of each line_----_�-d_l.---- ---Width of trench.--- �� Number. of line s----- 9 �;r Type of filter material--ST 4�k-Depth of filter material------� _.:_-:-----Total length_______ ______________------------__---- �.--.------ Seepage Pit: Dis#ante to nearest..well--------------__g---'Distance from foundSize: Diameter ation----------- Depth---------Distance to nearest lot line----------------- Number of pits---- -----------------Linin material--------•------------ El -------- I Cesspool: Distance from nearest well-----------------Distance from foundation,_.,- .__-- Lining material._---.---------------------4 gals. ❑ -Liquid Capacity-------- ' Size: Diameter-------- ---------------- Depth- g € Distance from nearest well..-.--------_----_ ---"--"-Distance from nearest building -------------------- PrivyJ -------- - ---------�- - -�----�------ v _.. --------•------- ❑ Distance to nearest lot line--_"---------------- -- ----------•--------•------------ -------- f I. ------------------------------- Remodeling and/or repairing [describe):-------------------------------------------------•------------- ----------•-----------------•••.---------------=------ 1 -------------------------- ---------------•------------------------ - F---- - ------- -----------------------,_.---a_______-_-_-__-_-_.-__---.____-_-_______..__-..-_____----_--_...__-_-----___.____-_-_-.._______-_----___--__-.--_____...-------------_--•-.-.-_. I hereby certify that l have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, St aws, and ru s and regulations of t e San Joaquin Local Health District. r ----------------------------M±Owner ane�f+ejr-Cewtcac#er� Si ned -� 'i/ ---•------------ -- -- - ----- _ l g 1 3 (Title)-- --------------------------------------------------------------------- (Plot pian, showing size' -----------------------------------------------------------of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r i FOR DEPARTME USE ONLY . APPLICATION ACCEPTED BY-_-.. ._ } �.f s----------- DATE------ ---------`�� - -- - -- DATE---- --------------•------••---•--------------...---------- REVIEWED BY------------------------------------- --- ------------- -------------------.--------------:---- -- ---------- ------ BUILDING PERMIT ISSUED------------ --------------------- ----•-------------------------------- ------ DATE--------- = Alterations and/or recommendations---------z--------------- ------------ • -----•--- ----, -- ..cam -------------------- ---- r -----Y------'----------- FINAL INSPECTION � �~�' .-'_ ------- -Date-..----------------------------- ------------------ ----------------- 13Y:.�'__ - - - - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 4 132 Sycamore Street 814 North "C" Street 130 South American Street +. Trac California Stockton, California Lodi, California Manteca, California Y. ES-9-2M ; " Revised W-2100 -