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5-✓ _-,-,0- 3;,/6" ✓ APPLICATION FOR SANITATION PERMIT Permit No- _ ... (Complete in Duplicate) Date IssuedOL"v Tglica�iodshereby 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----- -�_'q_746 6 .L....N--------------------------------------------------------------------------------------- Owner's Name---------------------------------------hl.&/s---------t.-WA, I - ---------------------- Phone Address-------------------------------------=----------- Contractor's Name------------------------------------------- ...... ----- - ------------------------------•-----•-- Phone_lrr�%_40_7---- Installation will serve: Residence V% Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other ❑ g !-- +�= I ' '----- Number of living units: ___ Number of bedrooms __ _ Number of baths ._f_.. Lot size ___ _ __ ______________ 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 ❑ Clay Loam ❑ Clay ❑ Adobeid Hardpan ❑ Previous Application Made: Yeso--Ej41 New Construction: Yes JC 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�N�Distance from fo nclation__1d+____ _-Material___G' +� No. of compartments--- .---------------Size- --- Liquid depth---- "; -__--------Capacity_, __.-__. Disposal Field: Distance from nearest well_140_4, ._DistanceIrom foun etio4_�".....Distance to nearest lot line__-�------ Number of lines___.. -- __ -- Length of each line------________p_�.9'Width of trench____a-c,L_�•.____.________..1 Type or filter material__1� _______Depth of filter material ____-_______Total length__ �________________________ p� 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. •y i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.--------__.________.__________- ' ❑ Distance to nearest lot line------- Remodeling and/or repairing (describe):------------------------------------ --------------•--------------------•-------------------- ------------------------------•------------------------ --------------------•---------•-------•--------- ----------•---------------------------------------------------------------------------------•--•--------- ----------------------------------------------------------------- ----------------------------- ----------•---------------•-------------------•------------- --------------------pas ----------------------------------- ---------•---•----------------------------------------------------------------------------------------------------------------------------------- I hereby certiat I have prepared is application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and re ions of the San Joaquin Local Health District. (Signed) "F' By:.-•-------------------- -- -------- - (Titlei---fS--l-_rrl_F� Q �'� --------------- (Plot plan, showing size lot, location of system in relati to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- ----------------------- ------------------------------------••-------------------- DATE-�-—•-------------- ------------------------------- REVIEWEDBY--------------------------- -------- ----- - - -------------------------------------------------------- DATE---- -w-�,----------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- ------ DATE------------'---- , Alterations and/or recommendations:----------------------------- ------- - -------------------------------•---•--------------------- •------------------------------•---------------------------------------------------•--•---------------- -------------------------------------------•------------------------------------------------------------------------- FINAL INSPECTION BY---------------- - ------------ ---------------- 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 ES-9-2M ;0-52 Revised W-2100