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APPLICATION FOR SANITATION PERMIT Permit No. _f_.__ / Jd W (Complete in Duplicate) (O Date Issued ________ _ _ Y Ej /02-r/ Application 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 Couriffy Ordinance No. 54 &S7 L44" /76 ff4er Z_ 91VC �_� �, -.------ JOB ADDRESS AND LOCATIO ----------------------------------------------------------- Owner's Name---------- -----------V�------ L E f�ta(_t / ----------------------------�---------------- Phone_/yo------------------i-- Address--------------- ----------- _� @ -- .' I1�✓ .................. Contractor's Name--- J9--- ------------------------------------------------------------------- ------ Phone--�� ll Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ syr Number of living units: I_____ Number of bedrooms --Y'- Number of baths I___ Lot size _k0 X_ 1. __'r_______________________ Water Supply: Public system ❑ Community system ❑ Privatey(�` Depth to Water Table_ ft. � Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Of Hardpan ❑ Previous Application Made: Yes ❑ No 4 New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: �Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1;ZN Septic Tank: Distance from nearest ell�f______Distance from,foundation, _..__.__.Material____ r .� _ No. of compartments-- depth , -_______Capacity__ F f i Disposal Field: Distance from nearest well-__ _______.Distance from foundation Distance to nearest lot line_��__ty-..... _Length of each line___ _1i Number of lines_-- ___�_�Y_-_�_-- ----_---_ 9 v��9_----•----j+-----.Width of french--- of filter material _ _ __ 8 __Depth of filter material----_-/�x___-___._Total length____..__ 1__ ____________________ Seepage Pit: Distance to nearest well___/0Q_______Distance„f ark fo ndatcon__ _, ___.-. ta��a to nearest to line K Number of pits____ Linin materFal-_ __Size: Diameter-rte __-___--__-Depth-- - g ------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___-_-___________�___________.__._-_. ❑ Size: Diameter----------------------------•---------Depth---•------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 11 Distance to nearest lot line Remodeling and/or repairing (describe) ------------ - --------------- -- - - ,t. L1__------ - -- - -- ----------------------------------------•--.-------------------------------- - ----Aan ----------------------------------- I herebyertif that I have prepared his application and that the work will be done in actor ------- - ---- y p p ppa with San Joaquin County ordinances, S t I s, and ruleis and r ations of t San Joaquin Local Health District. (Signed)--------- -- ----- -- ---- ---------- ----- -- - sii er aryd/o ontractor,0y:--------- ----------------- / r -------w- -------- ----------- - --- - -(Title}_--- Pon -- -- 1. (Plot plan, showing size o lot, location of system in relation to wells, gs, eft., can be placeeverse side)j. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------ --- ------- ----------------------------------- ------ DATE----------- _} y REVIEWED BY-------------------------------------- - DATE------------------- ------------- BUILDING PERMIT ISSUED-------------------------------- DATE Alterafionsand/©r recommendations----------- ------------ -- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION "�,�.,�- Date - ' ..�.r.. --------------- ------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Ivfanfeca, California Tracy, California ES-9----2M 8-51 Revised W-2100