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APPLICATION FOR SANITATION PERMIT Permit No. ___ ------------ 1 � f ` - �. (Complete in Duplicate) . -J Date Issued -- Application 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. os-,7— beto--0 JOB ADDRESS AND LO�COA-elN_�"'..90v,5C--- Owner's Name-o f�R ------A-Ye-:----------- : W11_I/.AN[------Y14/6 Phone---{/P----------------------- Address----- - � iq.. _ 1 �J--------Aze-F------------------------------------------------ --- -- ------------•--------------------------------- Contractor's Name------------_b--p---A-#------- ------47 --- aS_QeN�sJ------� C-j---------------- Phone--�---- i�,0--7-------- Installation will serve: Residence �( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:E7& Number of bedrooms�Number of baths C7!-(e Lot size /cQQ_**__X___1.7 --_ ------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table46- ft. _ Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam E] Clay Loam [] Clay ❑ Adobe ( Hardpan R � Previous Application Made: Yes ❑ No 0 New Construction: Yes ) No ❑ U , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,y Septic Tank: Distance from nearest well_ �----Distancefrom foundation_._/0---____-MaterlaI___0- RNC-/Q67�.------------------- 9 No. of compartments___-,;1"7W_ _0-________Size_�~--�4"-_A _X_D,_Liquid depth_.. ------------Capacity_6110_0 _6�14_ Disposal Field: Distance from nearest well__---------Distance from foundation---eg43.........Distance to nearest lot Number of lines-----0W_A--------------------Length of each line----�-----------------.Width of trench- �y 4r1--_---------- Type of filter material jyA".Rfl�___Depth of filter material-__42--_______Total length____s.�-_____________________of 1 ti__.. Seepage Pit: Distance to nearest well----71-----------Distance from foundation---Zl-______..Distance to nearest lot line_____________ 9 Number of pits_-Qf✓-— Lining material-B_R_!_G&_.Size: Diameter___.33_ ------Depth---;V,1_'_________________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material._----___________________________- ❑ Size: Diameter ----------------Depth---------------------------------------------------_Liquid Capacity---------------------------gall i Privy: Distance from nearest well-----------------------------------_--------------Distance from nearest building------------------------------------------ 17-1 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) ------------- - -- - ---------------------------- -- ---------------------------------------------------k ---------------------------------•---------------------•----------•-----* _i:i l ±-------•- A-l_.�------ ---Mew------- �r V, -----------•-----------------•- ------------------•-------•----------------------------------------•---------------- ._..-------------------------------------------------------------------------------------------------------------------------- -------------------------- ---------------------------------------------------------------------------------- ------------------------------------- ------------------------------------.----------------------------------- 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 a regulations of the San Joaquin Local Health District. (Signed)------�t-----/-A_-0------------- i �� =/ ---- ------'. �5-------- ---------------(Owner d/or Contra or). -- _ ------(Title)--- BY� f (Plot plan, showing size of lot, location of system in rel tion to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------------------------------------ ---------------------------------------- DATE ----------------- ------ REVIEWED BY------------------------------ -- ---- --- -- DATE -- PERMITISSUED------------------ --- -------------------------------------- --------------------------------------- DATE------------�z:-------------------------------------------- Alterationsand/or recommendations--------------------------------------- ----- ------------------------------------------------------------------------------------------------------------- --------------------------------- ----------------------•---------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- F1NAL INSPECTION BY: Date12 ------------- ------ -------------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES----9-2M 8-51 Revised W-2100 •�l