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�,. APPLICATION FOR SANITATION PERMIT Permit No. 7 li D i l (Compete n Duplicate) ]r. Date Issued Appllca{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 Ordinance No. 549. a�c1 JOB ADDRESS AND LOCATION----_�-_M(,�----�•S,,a-kl-�.4`G�1�Y1-t-----y�a�- -R-o-----•�----------------,---------------------------------------------- Owner's Name-------. _ns��.t�' A,----Y''II Jj V-el------------------------ ---- - -------------- Phone.--- ``-- --•--- Address----- ------------------------------------------------------•----------------------L! ti '--p . .J��-6A Contractor's Name-------------------�-�-�--- --'�-'------------------------- ---------------------- ---------------------- ---------- ------ Phone../.}' `----'----------- � Installation will serve: Residence D( Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelP Other F11I i Number of living units: __.j____ Number of bedrooms ---I--- Number of baths ____l___ Lot size --- -X Water SuPPIY� Public sy stem Community system ❑ Private � Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No'R New Construction: Yes,0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if } ubli 1 sewer is available within 200 feet.) / p N' /Q _ --.Material--.�'CAgPP Septic Tank: Distance from nearest well_________________Distanff��frfountion__ ___-___. No. of compartments------2---------------Size_`-,U ---•---- -------Liquid depth-------4- Capacity p06// -_.Distance to nearest lot line.___-_---_ Disposal Field: Distance from nearest well___�_D__..._'D'stance from foundat• n______ 4-4 Number'oi lines--- ____.. Length of each line__' - V�idth of trench_.____ _ ___ __...___ ---- ��; Type of filter material_S!r� ft---Depth of filter material------/------- _.___Total length_____ - 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 materia!___ ------------------------------- LiSize: Diameter------------------ -------------------Depth-------------------------------- - -----------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------ ------------------------------------------Distance from nearest building______..______.__-----_--_-_____---------. ❑ .-------------------------------------------------- El .. _ Distance to nearest lot line--------------- --------=------- ------- ----------------•----------- ------------------------ -----------•------------- -------- Remodeling and/or repairing (describe):_ TAW ----------------- ------------------- G` ------/S----- ------------------ --- - D_KJ M-------f?-1. -- -----��_�,0.7"".. x I hereby cerfify.that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. « -________(Owner and/or Contractor -- --------------------------------------------(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____3 --- REVIEWED BY-------------------------- -- ------- -- -------------- -- ----------- DjE--------------------------------------.-.--.-. -_------------- BUILDING PERMIT ISSUED---------- DATE---------------------------------------- -------------------- Alterations and/or recommendations:________ ----------- -------- ----- y --- ----------� _ -- ------•-------- -- --------------------------. f -------- ---------- ---------------------------------------------------------- --------- ---------------•--- - -------------------------------- --------- - ----------------- /�!� ! ------- - Date----=-------- �� FINAL INSPECTION $Y--------- --- ------------------_ :. .�_ ----- ------------'�f`�._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M Revised W-21001