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Ll APPLICATION FOR SANITATION PERMIT Permit No. __S�17__ .- (Complete in Duplicate) Date Issued Applica+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. JOB ADDRESS AND LOCATION...------- -- D - ---- ..-------_B-- L-� ------------------------ Owner's Name_---------0--S--_C-_1.7 --------••-- �T---•---•-------------------- ------------------------------------------ Phone_1Tf�. -1' Address---------- .9�0.5_------8--------2Vfi` h-l A --.jQ- -----------------------•------- ----------------- Contractor's Name-----�_ ..�q --'--C�- Arm- -- --i __ ��" �" :.- Phone__*A._a- �`Cdi7---- I Installation will serve: Residence ® Apartmen+ House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _ '_. Number of baths ---t--- Lot size ,I Water Supply: Public.system E] Community system [� Private E] #�_,Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No © New Construction: Yes J 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------ -------Distance from foundation--------------------Material------ �r_ XI�1 /t`f� No. of compartments---------2--------------Size_„-G--�-�L-1C-�-�---Liquid depth-------,�-�------------Capacity---po0�� Disposal Field: Distance from nearest well_________________Distance from foundation-----------------_Distance to nearest lot line-_________-_..__. ❑ Number of lines-----------------------------------Length of each line----_-------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total iength------------------------------------------ Seepage -----------------------------------•--.-- See a e Pit: Distance to nearest well--------- _____-------Distance from foundation.......1 d_ ____.Distance to nearest lot line------ °------ ® Number of pits---------/-----------Lining material.:Cg_.6RWG ize: Diameter-----33------------Depth-------D_2-,r Cesspool: Distance from nearest well-----------------Distance from foundation.____._--- ---------Lining material -__________________________________ �R ❑ Size: Diameter------- ---------------------•--------Depth- -•------------ I---------------- ----------------Liquid Capacity..........•-----------------gals. Orf Privy:: Distance from nearest well-----___-----------------------------------------Distance from nearest building__---____________________-------__-----. ❑ Distance to nearest lot line------------------------_---------------------------------------------- ----------------- r Remodelingand/or repairing (describe)----------------------- --------------------------------------------------....------------------- -------------•-•----------------------------••------ ' 44---------- ----------------------------`-----------•---------------------------•------------------.-------------------------------------•----------------------•--------------------------------- -_________[____________________________________________________.,_..________-...________---_--__-______________-_..-.._.______________-__---_---____.___________________-__________-___-_________-_____-____________---___.____ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ 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 +he San Joaquin Local Health District. Si ned f" /� 1y.�1�c4. 1�.�. 9 t )---•-....--;-- -------------------(Owner and/or Contractor) By:-----------------.......----- -----------------= `��'-tr- : -------- �_- s---------------------------------------- Plot plan, showing sizes of lot, location of s sfem in relation to wells buildings, etc., can be laced on reverse side ( P 9 � Y � 9 . P )- " FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY ----------- - ------ ----- - ------------------------------------------------ DATE------------ � r REVIEWED BY -------------- DATE------------- - __ BUILDING PERMIT ISSUED Lw-- ------------------------------------------------------------- DATE Alterations and/or recommendations:-•-------------- ---------------------------- --•-------•----------------------------------------------••------------•-------•-- -------------------------------------•---------•-------------------------------------------- ------• ----- ------------------------••---•---------•------------------•-------------------•------------------------------- -------•------------------------------------------------------------------------- --------------------------------------------------------------------•-----------------------•------•----------------------------•----------- ----------------------------------------------------•-- ------ --- --------------------------------•-------•----------------------------------------------------------------------------------•------------- FINAL-- INSPECTION BY:_'� , - -------------- J . 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 � Revised W-2300