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14-11141 APPLICATION FOR SANITATION PERMIT Permit No. ._.,5-_9V... (Complete in Duplicate) a s2 Date Issued __ – . ...._ ca� 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 OrdinNo. 54/� (��GVP" JOBADDRESS AND ATION... ----�------------------------�•------------------------------------------------------------•----- ----------- Owner's Name ...IST •-•- tfT. ----•-------------------------------- ------ Phone.__ Address-------------- k 4. Contractor's Name . -• �. Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: ....1_ Number of bedrooms -___L Number of baths ---L. Lot size ---------------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table /_4_**ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayP(Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No VNew Construction: Yes 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---6.0.0.Distant fro undation__-.�__J�__---------Ma ____ _. . . -.*.. No. of compartments_____.._"/__...______Size___ _. ? __Liquid depth__ / / Ca aci ._._-- ----0--- P tDis al Field: Distance from nearest well---.(D_04__Distance o foundation_____91......Distance to nearestlot .... Number of lines---__________ ------------ ___ _ _ --__. Length of each line__ D__--_ --3�1Width of trench-------rr_Z�tL'�..a._....._. Type of filter material_ _ _Depth of filter material----/_�_-_-_____Total length_-____-_b__Q___-___•-------------- -- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_.-.-___---_----_-_-__-Depth---------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.___-_-_-_-__-___-_____-__-.-_-•.... Size: Diameter-------- -- ---.Depth------------------ -----------_ Liqui - ---------_-----------gals.well. -- ❑ Distance t�nearres l e---------------------- ---.--) �x....---- ---------------- --------------------- -------------------------------------------- Remodel. ------------ Remodeli g andr re airing (des �tJ�J�/�y► - ibe): l4r - t._... - - . ------------------------------ --- --------------•- --------------------------------------------------- I 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 the San Joaquin local Health District. (Signed)---- --------------------------------------------------------------.-.------------------------------------(Owner and/or Contractor) BY�= - ---- ------------------------------------------------------------------------------------------(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 BY -- DATE BUILDINGPERMIT ISSUED---------------------------------- -----------•-- - ------------- ---_- DATE..--� ------------------------------------------------ Alterations and/or recommendations--------------------------------------------- ----------------------------------------------------------------------------------------------------------------- --------------------------•------------------------------------------............. ----------------------------------------------------------------------•------------------------------•---------•------------------------- ---------------------------------------------------------- -- ------ --- ----------- ---------------------------------------------------------------------.--------------•---------------------- Q0.00 FINAL INSPECTION BY----------------------------------------------- " Date---------------- V s�`� ------------------------ 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-2100