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�.+ . APPLICATION FOR SANITATION PERMIT Permit No. (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. JOB ADDRESS AND LOCATION---100T 3_..-C,___l. r ______ ____.____�]� ------- Owner's Name ' l �lC_ -(/-�C� �--4----(gv�-- �l aN 1- .- -- -------- --------------------------------------- --- - Phone _~_6_-z--------------- Address------- --..-.--- Address------- -------' Contractor's Name----- .Q-r!'1 l�I/e_1- e1�S 1�-------------------------------------------------------------------------------- Phone---- ------- Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A----- Number of bedrooms ._�---- Number of baths ---I---- Lot size ----- 5---X--opS-----------------------__ Water Supply: Public system 4 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 0 Hardpan ❑ Previous Application Made: Yes ❑ NotZ, New Construction: Yes M No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f� , f Septic Tank: Distance from nearest well.h_a�'I_'Q_Distance from foundation_1-0-----------MattIe''riai---__1-- ----�___dy�o�•'1______-. No. of compartments----Z..--_---_-.--Size-_-5 X-3--X_5_.__-Liquid depth--_-----`i----------------Capacity----ff__-6-0--_--� Disposal Field; Distance from nearest I.7??7Y1l�-Distance from foundation---_Z-Q-�----.Distance to nearest lot line��_�_--._- Number of lines---------_-_ .-__... -__Length of each line_Zd__t__ v-----_Width of trench.------ Type of filter material-5_14,0--k--Depth of Cfer material---- ---.Total length-------—7Q-_f------------------------ ' Seepage Pit: Distance to nearest well--------------------_Distance from foundation-----------......_Distance to nearest lot line----------------- 1-71 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 yell.---- -------------------------------Distance from nearest building---------------------------------------._ ❑ Distance to nearest-lot line---------------------------------------------------------------------------------------------------------------------------------------------- i-N 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, S ws, a d rules and regulati f the San Joaquin Local Health District. (Signed--- --- ----------- --------- ---- ------- -- ------------ -----------------------------------------------------------(Owner and/or Contractor) By------- ----- ---- ------------- - -- .--- -- - - ---- --------- ---------------------------------------------(Title)--6' a ----------------------------------------- (Plot plan. sho P si of lot, afion of sy m rel tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ----- ---------- ---- - L '----------------------- DATE---2 REVIEWEDBY ----------------------------- DATE------------------ •---••------------------•--------------- IDIN PERMIT ISSUED-- �, 7DATE Alterations and/or recommendations:---- �d_ f -' - + ri 1_vt .. � �Y � rrFs } 1�r ;T '.. ` i -/ / .-- ---t•---�. - - .- -- y"v'-L--` '�`�.S-5... - --�^ -•_�5. -T-^�CG'.:. -• =1061 -'-4_---`-.--f_ Of%A0,el - a.,n'. 1t mss_ -r�i.s. -_lI�: r �j�� FINAL INSPECTION BY 1�N------ ---------- Date--- --- -- -------- ------`------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES-4-2M Revised W-2100