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:fed . a APPLICATION FOR SANITATION PERMIT Permit No. . __�___ILI- 'i (Complete in Duplicate) / Date Issued .6ly /S- Application is hereby made to theInS J aquin ocal Health Di rD�s r a per onstruct and install the work herein�d_esccr�i�bed. This application is made in compliw h Co ty O�d�inan JOB DRESS A LOCATION ----- ------ - - ��-'`�-7 � - --------------------------------------- OwnerOwners Name--- ---V-��-•--- ------- -- -- -•- ------------ --'Pa--�' 6=�-- ----- Phone------7' ------------- Address -----a----11---1-----c--'--- --- ----------- ---------------------•--------------------------------------------------------------------•------- Contractor's Name--_----------•-•--• �---- - ------- -----------••--••••-----•____________........... Phone----•R=-I-- 7------ 7 O- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [� Number of living units: -------- Number of bedrooms -------- Number of baths ........ Lot size ........._____________________ � Water Supply: Public system. Community system ❑ Private--,WDepth to Water Table 49 ft.+ - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 1i Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ �yr.��•�-•�7' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellfle+_Distanceir m foundation lD ___.Material___ - -- -u. .l 8 �. No. of compartments__-__'�-_--___.___Size_-�4+_ s " _ _________Liquid depth__34�-_--_---___--Capacity1l ___._ .r� i Disposal Field: Distance from nearest weil.�0_';d_____t_--_.Distance from undation___!Q_ -----Distance to nearest lot line__fOCf._� Number of lines___----------- M_ Length of each line----iXD_77__--�___-Width of french_4ffA_-_��_________________ g Type OT' filter material___!E_ )--__Depth of filter material------- -r -- length--------------/s"'7?___-"________ Seepage Pit: Distance to nearest well-----f--------------Distanc oundation_� _____._.Distance to nearest lot line__ Number of pits----/---------------Lining material- ------Size: Diameter---JJ------------.Depth---1-O---------------------- Cesspool, Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------galls. Privy: Distance from nearest well --------------__-_-___-__________.-----------Distance from nearest building______,___-_________-___-_____-__----_-- ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------•-- -----------------...................................... -------•------------•-----------------•-• ----•---•••-•--•---•••-•••-••-•-••-----------•--•--_________.------•---•---______•__-----•-•-••-••----•-____------------------------------•----------- ----------------------- I reby ce that I have epared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , an rules d regulations of the n Joaquin Local Health District. ' . 0 (Signed)----• ------------•--•------------------------------------------------- -- ------- ----- ---- ------------------------------------------------------ - Contractor) ----------- --tngs, ------------------ By: (Title) ' - (Plot plan, showing size of lot, location of system in r lation to wells, bu' etc., can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - . DATE• .................................................. REVIEWEDBY ---------------------------------------------------------------------------------- DATE 'j.,-----------•------------------------------------- BUILDING PERMIT ISSUED-----------------------------------------------------------------------------•••-...................... DATE--------u---------------------- ------------------------ Alterations and/or recommendations:--------------------------------------------- -------•--••••--•-•••---•-••----•••••-••-•-••-•--•-••-•-•••---••---••---•••-•-•-••.___.__.--••-•---------------- -------------------------------------------------------------------------------------------------------------------------------------------•-------•-•-------•------•-------•••-•-••••--•-.................................. -----•-•--------------- -------------------------- ----------------------------------------_•------------------------------•------••••••---•---•-••-•------------................... --------•------------------- -------------------------------------------------------------•--- --- ------------------ ----------------------------------------------------------------------------------------- ......................... FINAL INSPECTION BY----------------- --- ---------------- ---- Date--------------------------(---Z —`�. 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 I0-52 Revised W-2100