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�j APPLICATION FOR SANITATION PERMIT Permit No.��..� __0____ e (Complete in Duplicate) ,%—t/ Date Issued4�___ __________7 Appiica4-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. r JOB ADDRESS AND LO TION------�5 ----- ----- K•xs,l___��.. J Owner's Name--------�/4---------- ----- -- --- - ---------------------------------------------------------------- ---------- -- Phone 7__,e1�,7�/------- Address-•---------------------- Contractor's Name- ,.K '—•------------------------------------------- -- -•-------•-- Phone..1667---4nf-4 ?� Installation will serve: Residence B`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_j___ Number of bedrooms 7 Number of baths ---/--- Lot size -----S _A_�___r_LS_-.� . //� .- ----- Water Supply: Public system �<ommunity system ❑ Private ❑ Depth to Water Table '-CJ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3--44ardpan ❑ Previous Application Made: Yes ❑ No gi_ �lew Construction: Yes ❑ No [] 0 TYPE OF INSTALLATION AND SPECIFICATIONS: • (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Ta ki Distance from nearest well-----------------Distance from foundation--------------------Material----_-_.-__.._----.-----.-_------___.--.-___--__. No. of compartments-------------------------Size.......... ---------------------Liquid depth--------------------------Capacity----------------------- Di 9bsall Eigid, Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_----_-------.--- ' �oJ Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of fiber material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage ----------------------------------------- See a e Pit: Distance to nearest well______________________Distance fro fo ndation____-___-__-___-_.Distance to nearest lot line------- _-_____ p 9 / � G Number of pits----- Lining material_ 5ize: Diameter___ - >f.._.Deptn_..%'� ' 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 11Distanceto nearest lot line--------------------------------------------------------------------------------------------------------------- - V Remodelingand/or repairing (describe)---------------------------------------------------------------------------------•--------------•-------------------------------------------------------- ---------------------------------------------------------------------------•----------------------------------•---------------------------------------------------------------------------••---------------------------------- I ----------------------------------------------•---------I-------------------------------------------------- ------------------------------------ ---------------------------------•------------------------------ -ISate -----------------•------ -------------------•----------------------------- -----------------------------------------------------------------•--------•----------------------------------------- I herebertify that I have epared this a lication d that +h work wll be done in accordance with San Joaquin County I ordinances, laws, and rules d r gulatio of the n Joaqui "or Il,' Ith District. xx (Signed)--------•---• ------------------------ --- - ----- ---L-- ------ ------- - ----------------------- --- -- Contractor) i By:--------------------------------------------------------------------- ------ ----zz-------(Title]-_ j_,'ji _ Q ��-------------------- (Plot plan, showing size of lot, location of system in r tion to wells, buil can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY- --- ------------------------------------------------------------------------------------ DATE-.�---------••------------------------•--------------- REVIEWED BY------------------ -------- - - ---------------- ---------------------------------------------------------------------- DATE--- iF BUILDING PERMIT ISSUED - DATE 1K I Alterationsand/or recommendations:----------------------------------------------------------------------------------- .---------••------------•-------------------------------------------------- -------------------------------•-------------------------------------------------------------------------------------------------------------------------------------..-..-------------------•------------....---•------------ -------------------------------------•-------------•------•--------•- ------------------•----------•- --------•------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ---------------------•-----•----------•--------------------------------•---------.---------------------------------------------------------------------------- --------------------------------------•-----------------•-------------•--•-- • ---------------------------------------------------------•-------- --•----------------------------------------•- -----------------•-------------- y - FINAL INSPECTION SI jBY:. S ------------------------- 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 I IRevised W-2160