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e APPLICATION tOR SANITATION PERMIT Permit No.t __ .-1-_k-______ (Complete in Duplicate) Date issueA_.3 jJ3 P aw r Application is hereby made to the San Joaquin Local Health District for a permit'to construct and install the work herein ribed. ; This application is made in compliance with County Ordinance bio. 549. e � JOB ADDRESS AND LOCATION..��,,� �P17 ��-�--------------------•------------------------------------- --- !� a I Owner's Name_ /e_ ,,�1/1 -C -------------------------------- �° /;5�--�-tom! -. ------- ----------------------------------------- Phone---If w-��-------------------- I Address--•---c,.z- ,a,- �:�e� --------------•---------------------•---------------------------------_-----------------------�.-•--------_-------- ----------------------- Contractor's Name._tleffXX e,. ---/ tj ' .,i�fd ------------------------------------------------------------- ------------- Phone...142el�---------------- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Offer ❑ Number of living units: I---- Number of bedrooms __/___ Number of baths ._J__ Lot size •----------------------------- Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑,Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes g] No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-----7.5e*__Distance from founga+ion_10'_-`_.___.Material_ e411 No. of compartments.____ ____Sie A--/GdLiquid depth___ 'j__________Capacity_�/�-C� k_ --- __ ! Disposal Field: Distance from nearest well __7_0------Distance from foundation_/A_�f-----Distance to nearest lot ___J_ Number of lines_______ ______ Length of each line---------6.42_ ---------Width of trench__ ___ - Type of filter material___ G ---_____Depth of filter material------ ,0_ ......_Total length:_'-----44i___________________-____ Seepage Pit: Distance to nearest well-------------_--------Distance from foundation____-_-.__-__K____.Distance to nearest lot line________.__-____- ❑ Number of pits----------------------Lining material-----------------------Size:'Diameter-----------------------Depth------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.____lining material_____________________________________. r❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. privy: Distance from nearest well---------_------------------------------------ _"Disfance -from nearest building___ �"�------------------- ❑ Distance to nearest lot line_ . ---------------------------------------------------------------------------------------------- -------------------------- • r Remodeling and/or repairing (describe):----------------------------------------------------------- ------------------------------------------------------- -----.----------------------------- 9 ____________________________________________________________________________________________________________________________________________________y_„_.___.____--__-_______________-_--_-_____________.___-________________ ___ _ _ ___________________________________________________________________________________________.___.__„___________________________________-.__________________.________________--_____________._______________- h I hereby certify that I have prepared this application and tha+ +he work will be done in accordance with San Joaquin County ordinances, S+ate, laws, and rules and regulations �offhhe San Jo`quin Local.Health.District.; (Signed) �t . '.d. Owner and/or Contractor B ------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ -- --- --- ' --------- ------ DATE--- -- --------------------------------------------- REViEWED ---------------------------------- REV€EWED BY--------------------------------------------- - -- -------------------------------------- DATE-- .� - ---------------------------------------------------------------PERMIT ISSUED-------------------- - - ----- --------------------- �/ -,,t DATE Altera+ions and/or recommendations- ------------------- ----- ----------------------------------------------- ------------------------------------------------------ -------------------------------------------------------------- ---------------------------- - --- `-------- ----------------- ----- ------------------------------------------------------------------------------------------ .. FINAL INSPECTION BY--------------- ------ --- Date----- �� + SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street 300 West Oak Street 132 Sycamore Street. 814 North "C" Street Stockton, Caiiforni5 w Lodi, California Manteca, California Tracy, California ES-9-21VI 8-54 Revised W-2100