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�d7 APPLICATION FOR SANITATION PERMIT Permit No. _______________-____: (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:!---K'--v4-- --G.j P2L'V---a_i--- ` f- - '4- ---fjn -v Owner's Name � _•= Phone _• la Address-----------------------------1,57-1 - t 1 ! ' ------- Contractor's Name------------------- -IkJt.l1. . _ --------------------------------------------------------- Phone&___,6s--,-,07 Installation will serve: Residence ,Q'Apartment House ❑ Commercial El Trailer Court' ❑ Motel 0 Other ❑ i Number of living units: J- Number of bedrooms __'Number of baths -_I_._ Lot size ----4Jre�r_X____f E?4 _9_________________ Water Supply: Public system ommunity-system ❑ Private ❑ "Depth to Water Table':04/nt?ft. Character of soil to a depth of 3 feet: 1 Sand ❑ , Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No © New Construction Yes [[?I-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspoolpermitted if public sewer is available within 200 feet.). s p Size-- - --�� `_ __Liquid depth_!_..--_- -----Gap ' Septic nk: Distance from nearest well__�D��.__Distance from foundation__._..-..........Material__ -_- _ _-___-. No..of coni artments__ acity____�Q_� �`'� Disposal ield: Distance from_ nearest wef i- _...__ Distance from fou anon__ ___ ___________ d __� Distance to nearest lot line---- ---_-____ Number of lines------=---!-----------------------Length of each line--- ---------: Width of trench--2_V'!----------------__--- Type of filter material-_t vyA______-:Depth of filter material__l-8°f__.--____.Total length_____aD_`__________________________ Seepage Pit: Distance to neare t well_.�ily-)--------Distance from foundat:on____+`c______`T__..Distance' to nearest lot line----c�_-__----- Nu ___- ti [ Number of pits__ __________________Lining material_Ac ,'iC��__.Size: Diameter____�_�_'4Depth_: .`�a-,��__________--_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------_____.Lining material _.--______-____-----..-_-___________- ❑ Size: Diameter------------------------------ ------Depth-----------------------------------------------:-- -Liquid Capacity----------------------------gals, �. Priv Distance from nearest well-._.____--------------------------------- $ Y�: , --------Distance from neares# building------------------------------------------ -Distance-to - ----Distance-to nearest lot'lire---------------------------------------------------_ Remodeling and/or repairing (describe):------------------------------ - -- - '"" + ----•------• ------•-•---------------------• ----------- ---------:- ---------------------•-----•-------------------------------------------------------------------•--•--------------- -------•--•-----•----•--------------•------------------------------------- -----------•.............-------------------------------------•---•--------•-----------•---•----: --'W --- I hereby ertify that I have prepared this application and that the worVwill be done in accordance with San Joaquin County ordinances, te'laws, and rules .and regulations of the Sari Joaquin Local Health District. ---------------------- k 1p'_�jt ---------------------------- .. Contractor(Signed}------ - �4�_IF'll -- ---- - ----- ----- --------•-- ----------- BY:----------------------'.. (Ti+le]--h�.s� 1.h'1_ .f''_ ...... (Plot plan, showing size''of lot, location of"syste-nn in rel ionto wells uildiings, etc., can be placed on reverse side). 9 FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY------- _ _ DATE_ -_ - REVIEWED BY-------------=----------------------- . DATE-_ BUILDING PERMIT ISSUED......... == •- ------------------------------..__..- DATE-----------------�~- Alterations and/or recommendations:--------=---------------------------------------------------- ------------------•------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------=------------_-------- -------------------------------------.__..-.------•----------------------------------•- -------------------------------------------- -------------'-=------------------ -------- ---------- --•------..-----•- --•--•----- ------•-------•------ ----------------------------------------•---•----- ----------------- ECTION BY: FINAL INSP -------•------------------------- -- Date.-. ��b *� --•-------:_-:----------------.- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American•Sfreaf 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100