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4__�AIIIICATION FOR SANITATION PERMIT Permit No, — (Complete in Duplicate) Date Issued _dP � 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. 599. JOB ADDRESS AND LOCATI jq. y '� Owner's Name..-----'"'R' "°- - -------------------------------------------------------- -------------- Phone--- o--•------------------- Address � �� tiD -------------------------------------------------------------------------- Contractor's Name--- l !------- -- s._l ------- -------------------------- Phone--- ��J ------ Installation,will serve: Residence [" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-/---- Number of bedrooms _Number of baths ./----- Lot size _:5_1x------lc Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table"6_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay El Adobe Hardpan F] t i Previous Application Made: Yes ❑ No New Construction: Yes No E] y) TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is avaiia6le within 200 feet.] i Septic Tank: Distance from nearest well- ' -r ------Distance from foundation----�--_-_----.Material---4,0AWe7Z— - No. of compartments __ �� r•-�1 Liquid depth_-_-\1_.Z"__-----_Capacity-- fl-s'J_ i¢I p 11VO------Size___-�-- Disposal Field: Disfance from nearest well--- Distance from foundation- f -- �(� +�---- �_---.--__-Distance to nearest lot line----- --------- Number of lines___' -- _ ___------Len Length of each line--- -_-_ ` ---.- 9 ��----- Width of trench_--- Type of filter material_ �-('i 6-__-__-Depth of filter material___-- -- --�! Total length_---____� ------------------- Seepage __----_-------------- --- p g ,A ---------Distance to nearest lot line--.5 ------ See a ePit: Distance to nearest well-/-/O- ftom foundation- Number of pits--C - ..______Lining material_-- f__] lC�`� -Size: Diameter_- ___ r� � `� i� Depth---0a,-- Cesspool: Distance from nearest well-----------------Distance from foundation._-_____----_-_---Lining material--------_____---------_----_-_-----_ :. ❑ Size: Diameter------------- -----------------------Depth---------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest wall---------------------------- ---------_--_____---_Distance from nearest building_-------__-_---------__----__-_ ❑ Distance to nearest fot line Remodeling and/or repairing (describe):-----.!% 'i -- ----1------ --•----- --`'�`-ice ---------; ------------ - -------------------------------------------------------------------- --------------------=-------------------------------••----•-----•--------------- - ----------------- -----------------•-------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------•------------------------ I hereby certify that I have preparecl)hj application and that the work will be done in accordance with San Joaquin County ordinances, a laws, and ules and regula ons of the San Joaquin oval Health District. S;"o/YS (Signed -------------- > � ,��4.------(Owner qnd r Contractor) C By: � ------ f"C ' - r -----------------------------(Title-------- (Plot plan, showing size of lot, location of system in rehtion to wells, buildings, etc., can be placeson reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _.__ DATE-- ---------------------------------------- -. REVIEWED 13Y - - ---------------- ------------------- --- DATE-----� BUILDING PERMIT ISSUED ------------------------------------------- ------------- DAT£-------------- __ ------------------ A aerations and/or recommendations: - ----- --------- ----------------------------------------•-------------------------------- FINAL INSPECTION [3Y: ------------- 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 B-51 Revised W-2100