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A3'sAPPLICATION FOR SANITATION PERMITPermit No. } ''J (Complete in Duplicate) rT�plication Date IssuedAis hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. 708 ADDRESS AND LOCATION cPO-2--- s ---- __ !------------ -------------------- Owner's Name------------------------ ----------. -�f 1 -r1Q� ------------------------ Phone "`= --------------- Address --------•----- -. Address--------------------•----------------•-•---------� ------ ------------------- -= Contractor's Name-•------------------------P"_�-n-�-e�. � .--- ---------- Phone../q r ` � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1__JI-Number of bedrooms &--- Number of,baths ___L Lot size ___ ----______________ Water Supply: Public.system jK, Community system ❑ Private ❑ Depth to-Water"Table _�ZDft.I _ i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.-Loam ❑ Clay Loam ❑ - Clay ❑ AdobeM Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No.❑.� .- , � TYPE OF INSTALLATION AND SPECIFICATIONS: t j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__1A,Q__fl_)__Distance from foundation---- I_S_.... Material---- r__ �_______________ No. of com artments--. _ . Size_ q p Capacity_A:97 R/s 6 :5, P p_� - r t - - -Q�.- -------.Width of trench '�' t line l0 r Disposal Field: Distance,from nearest well'.. _0-r}E-_Distance from foundation_/-�'.' Distan ce to nearest [� Number o,i lines_------_-�-----�---_�f_--------Length of each line-----_ g ' -- ------------------------ Type of,filter material---)__ ___./ �---Depth of filter material----�__8----------Notal len th_f_.__ '_______________________ a R-- g undation___5-- _ _.-_.Dis ante to nearest lot line---t�r___ P _ -3.----Depth-- �A ------------------- Seepage Pit: Distance to nearest well_: Q_kf7=______Distance from fa Size: Diameter________ __ i Cess ool: " 'Distance from nearest well_________________Distance from fo nd Number of its..---_I-_______x_ __ Linin material. ____ ♦ A 4 Cesspool: ` ation-------------- ....Lining material---- ----'---=---------------------- L i Y 9 ❑ Size: Diameter------- ------ = Depth_ -'.." ',_ i---- als� Liquid Capacity_ t --�_____-_--Distance fromnearesr buildin Privy: Distance rom nearest vrell y' " -' g '= ' ❑ r .. t ------- Distance to nearest lot line----------------------------------------------- •------------------'-------------------- ----- - -----_-`----•--------------- Remodeling and/or repairing (describe):__________________ ` r . -----•-•-•-•---------•------------------------ -------------------------------------•----------------•----= -----------•-------------------------------------------------------------------------------- f ;}1 ---------------------------- -----------------------'•--•-----------------------.....-----•---i--•---------------•-•----•-----------•----•------------•--•----- -----•'-_-------- I hereby certify that I av prep red this cation-and,that the-work will -be done in accordance with San Joaquin County q ordinances,.State laws, an rule and regulations o the San Joaquin Local Health Dis rict. ;. - I {Signed} (�` "'---- ------------------------ ;` -- - -. ( Contractor) -- Tale _, ----------- gY - - ( } (Plot plan, showing size of lot, location of system in relation to{wells;buildin-gs, etc. can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- '� DATE _ -------------- REVIEWEDBY--------------------- -------- -- -------- ----- ------------- - ---- -----------,-.-------------� -------------------- DATE---- ------------------------------------------------ BUILDING PERMIT ISSUED. ------ ----- -- ------ DATE---------U_--------------------------------------------- Alterationsand/or recommendations:--------------------------------- ---------------------.-------------------------------- ------ --••---------------------------------------------------------- --------------------------•----•-----•--------------•---------- -•---------------------------------- ---------;-;---•-------------- •--------•-----•----------------------------------••-------_---------•------------------ ------------------------------------------------------------- -------------------------------------------------------• --•------------------------- -------------•---------------------------------------------------------------------------------- -------------------------------------- --------------------------------------------------------- ------------•---------------------- --- ------------_---•-----. FINAL INSPECTION BY::.-------- -- ------ Date_--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California �`cr; ' ES-9-2M 10-52 Revised W-2100