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j t APPLICATION FOR SANITATION PERMIT Permit No. ,._ -/_-- Q}/ (Complete in Duplicate) !�/ Date issued _---_-J �� x --5--) `pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549. ; described. JOB ADDRESS AND LOCATION........--f 3�S________ I €.fid -------------------- Owne'r's Name--------------- -------- ----------------------�Q Address------- •-----•....5 Contractor's Name x Q - d..-----} --------------------- Installation -----------•-------Installation will serve: Residence Apartment House ❑ Commercial ❑ Traileri Court ❑ Motel ❑ Other E] Number of livin6 units: _ - Number of bedrooms _ t 9 Number of baths -----_-- .Lot sizeWafer Supply:Supply: Public system ❑' Community sysfem ❑ `Private X Depth'to Water Table,V_ ft. Character of soil to a depth of 3 feet: . Sand [:1 Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No [a New Construction: Yes ❑ No ❑ TYPE 5OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt- ----_Distance from foundation__/.'—tj - ----.Material----`��f��U'f W No. of compartments--.-�- ---=Size-------- Liquid depth--.-4(u.............Cepacit 1ZO-� Capacity--- Disposal Field: Distance from nearest weil__C99Q__j___fDistance from foundation----Zi-*__-.Distance to nearest lot line-_OC?-.�_- �f Number of lines------ -... .._.-__----_Length of each line-__-_--.�' -------- __--.Width of trench-.-.'�/`�______.____-__ Type of filter material----__E--ale-�----Depth of filter material:-",_I*,�_'r�- ----Total length--------- ""Q__ Seepage Pit: Distance to nearest well_ ��------Distance from foundation -,c�O --..Distance to nearest lot line---V-Q_'._._ Number of its--------- _ K _ _ i? �- -_Lining material_--- o_[` __Size: Diameter----_,�-_---.-.---.Depth------s;;,?S----------------- Cesspool: Distance from nearest well--- -------------Distance from foundation---.---- _..'--.Lining material._.---__---_- G ❑ Size: Diameter---------------------- -----------Depth----------------------------------------------- '-----Liquid Capacity----------- ----------------gals. Privy: Distance from nearest Well ---_-_-%_k_---------------------------------------Distance from nearest building--, ❑ ' line-` _ -- -------------T---- ---------•-------------- _ - -------------------------------------- Distance to nearest lot „' " - ------------------- Y Remodeling and/or repairing (describe):-------- --------------------------- --------------__----------=-••-"--------;--=------ ----------------------------------------------------------- 4 --------------------------------- ------------------------------�:-7------------------------------------------.-----._-_----.._--.------- i ------------------------------------__-_-._---___----.-____------___-_----_-__-----_-_-.______-_-__•_-_.__-._---______---_--.-...__-_--.-•-__---..-_..-_----_-----____.-_----_--_____.------_----.----_-_---_-------.---- I hereby certify that I have prepared this-application and +hat the work will-be done in accordance with San'Joaquin County ordinances, State laws, nd rules and re ulations of the San Joaquin Local Health District.._ Si ned__..-___-- - 1 .g } ----- .- t----- u ------------- --- {Owner and/or Contractor) -------- --- $y:--------• - ----- --------------- -----------------•------------(Ti o } - --- ------------- (Plot plan, showing size of lot, location of sys in relation +"o wells, buildings, a+c., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-----------•-- ---------- REVIEWED BY DATES DIN PERMIT ISSUED DATE--------- ------------ BUILAlterations and/or recommendations------------------------ 9 - --------------- -------------•-•---- ---- ------------ g-_/.91-.`-- ---- -----G�?v L l !/� • = r�' y ! L.e 1 -- ----------------•- ----------- ------------------- _ -L.• ----------------------------- '.�--------------------- ------------------------ ------------------- .. _--•---------------------------------•-------•- FINAL INSPECTION BY: -------- CDate. �.'� , • . .. -------------------- N 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