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APPLICATION FOR SANITATION PERMIT Permit No. ..__G (Complete in Duplicate) /ol Date Issued ------- t)I e7 _".-__Die - z,?. n_oq Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in cgmplience,wi+h County Ordinance No. 5.49. Q 0.1 JOB ADDRESS AND LOCATION.... ._11BaT A LUQ. Rid -------------_- ........... Owner's Name._.---- -__..____ -----------••---------------------"....--......... . .. - •---' Phone......Lodi 9--.9358 Address................... �* Bpx 8�?� AC&IRR Os C31 f -•--- ...... --".............................. Contractor's Name____ ... .SQ�, ';_"VYfll-"•empa.0y-•others t0 d0 aC °4a1_work. _-_ Phone__________________ - ----------------- Installation will serve: Residence ] Apartment House ❑ Commercial ❑^ Trailer Court [) Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms ----4. Number of baths ..... Lot size _Jc---fl11CZaCI'8S -------_-_---- Water Supply: Public system ❑ Community system ❑ Private [E • Depth to Water Table ---6-0 ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam 1K] Clay Loam p Clay F] Adobe C] Hardpan❑ Previous Application Made: Yes ❑ No []j New Construction: Yes ® No ❑ Addition to old construction. TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Taxk: tD� 6 Distance from nearest well � ......Distancfrom foun __ ation_ l-0.._........Matfrial....CQ10rete------- ------------ p ® C,Fons rei♦ No. of compartments:-•- 2 _ Size--7-'-x4'-x5- -----.:__-Liquid depth----.-4.-. - -------Capacity_. x-35 Cu•f� Disposal. ' Distance from nearest well Distance from foundation J_.. a-----__.j.Distance to nearest lot line........ .t �J /�� Number of lines........... .............. �� } of each line4'Q- ... JA O,-.Width of trench... ....3...ft.e.__..__..___ Cm � r T e of filter ma+erial.rock 1- D p h of filter material1?"...t0 glotal length....................................... Seepage Pit: Distance to nearest well......................Distance from foundation.....................Distance to nearest lot line__._____.________ 9 7 ❑ Number of pits......-__......---- - Lining material------------ -------Size: Diameter-......................Depth----------------------:--------- S Cesspool: Distance from nearest well.................Distance from foundation ...................Lining material__.._ ___.._....____________._. �. �..❑ _. Size:.Diameter -_ :...:... .... =Depth-----------------------_----__s-_-_:ter,.,-.-LiquidzCapaci.ty-------------------------gals. Privy: Distance from nearest well.------------------------------------------------Distance from nearest building.......................................... ❑ Distance to nearest lot line --------------" ---------------------------------------------------------------•.._.•-----_----------.......... .......- - Remodeling and/or repairing (describe):._.Nei�r-.-constrtitction consists Of additional leaching lines as present lines are only about 20+ long. n..addi�ion---eoniiectiori-of...nji-6s to drain ��aash ub..wat"er aiicT kftcheri si ik water 'will"be"""ad"d•eda9--�zidic_a'_�"ed---- ....... .........•.......----- ---------------------------------------------------------------...--------------------------------------------------------------- ------------------------------- exsting_-_s_ept3.c--tank. Nein construction indicated on chart in ink. . . ------•----- --I ------------------------------------------•- - ------------- 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 and regulations.of +ho San Joaquin Local Health District, (Signed)_ ... _ - _ ------ --- --------- -(Ow,,, n,.Vgr and/or Contractor). oyrner (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse aide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --------------------------------------- DATE-•-- REVIEWEDBY------------------ ---------• --......._...............•-•-•-----------------"--•------------------......_............... DATE.. •---•----------------"------......----....----.....----•- BUILDINGPERMIT ISSUED....................................................................................................... DATE--------------------- - Alterations and/or recommendations:. -- ................................ ---•--•--•-•-•--------------------------------..._........_ .................................... -------------------------------------------------------------------------- ---------------------------------------..........................................-•----•................................. •--•--------------"--•---•----•----. ............... .......-------------------------------------..._-----------------•-------••--•---•----"--=----------------- ---•....•••••-••--•-...._..-----------.... ........ ----------------- ........ ------------ --•- - FINAL INSPECTION ----_-.'- `'--� Date---.. ...-•--•- ,l 1 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revised W-2100