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,A LICATION FOR SANITATION PER1...•f Permit'No. ._.. __-. (Complete in Duplicate) 1� Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and ins# �e.ein described. This application is made in compliance with County Ordinance No. 54.9. LOCATION `��3 •-----------'�------'-"!_/��-=----------------------------•- �} JOB ADDRESS AND OC - "ra Name--------- �'-----------K--'----------� Y Y__� " -' ------------------------------------------- Phone ---------------------- Owner's 4 Address------------------------------------------------------------------t•-- ------- --------------------------- Contractor's Name-----------------------------------------------\&14!GV)-------------------- --------------------------------------------------- Phone----------------------------------- Installation will serve: Residence 1k1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Ll Other ❑ Number of living units: -------- Number of bedrooms __,e __ Number of baths _______ Lot size ------- -r____________________ Water Supoly: Public;system l Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelo' Hardpan ❑ Previous Application Made: Yes ❑ 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 nk: Distance from nearest well__._*O------Distance from,foundation-----JQ----------Material_--------i�"_(_�-__----A-1______ _______ 4 [ No. of compartments----------2- N -------------Size----_ 7C�J_ _ -------•-Liquid depth--------- 4_,�--------Capacity------ gD__ Dispos Field: Distance from nearest well-----AD-----Distance from foundation______ __ .. to nearest lot line------5-------- [~ Number of,lines._____.___•--- Length of each line---(_-yv_-�0____.Width of french----.__._�� IY�� Total len th-----------I Type or filter material- -__�__ _�___-_____-__Depth of filter material ---------- g ?______________________ 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---------------------------------------------------------------------------------------------- ----------------------------------------------- x Remodeling and/or repairing (describe)------------------------------------------------------------------------•--------------------------------------------- . •-•----------------------•----------------------------- --•-------•-----•---------------------------------------------••--•-------------------------------- - - -----------------------1----------- ---•---------------------------------------------------------------------------._-- -------------------------------------------------------------- f ------ ---- - w ordinanQeeby cerci aws�-- -- ---------------------------�------ -•- ___--------- -•- ------- ----------------------------------------------------------------------------------------•------•-•--------------------------------- € hav ared plication and that the work will be done in accordance with San Joaquin County ,a�t nd and ionsions of the San Joaquin Local Health District. '1 I (Signed). ---- - - ------ ----- --------------------------------•------- --- ----------------- Owner and/or Contractor + By:---------------------{ ------------------------------------------------------------------------------------------------- -----------(Tit e)-------------------:---•-----------------------------=--------- (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. = ---------------------- ---------------------------------- DATE-------------------- -- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------ ---------------------------•----------------------------------------------•----•---------•-•------ ---------- -------------------------------•------=--•---------------------------- --------------------------------------------------------------._...-------------------•-------•------•------•-------•--------------------------------•- -----------------------------•------------ --- ----------------------------•--------------------•------------------- •--------•-----------. FINAL INSPECTIONjj" 2 BY-------------------1�--• • �--'/----�-A------•--. 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 k , ES-9-2M Revised W-2100