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1 '- ��,� APPLICATION FOR SANITATION PERMIT Permit No. ._.�� p�1 (Complete in Duplicate) Date Issued ____________ _ l� 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 County Ord' a�i o._549. r JOB ADDRESS AND LOCATION--- -------------- ------ n---------------------------------�------ Owner's Name--- �......4!--et( -W-0C9. ----------------------------------- ---------------------------------------------=------ Address---------------------j-?-(a.4C---- F7. _Q er------------------- ----------------------------------------------------------------------------- ---- --------------- Contractor's Name----- _Q�L.1�- _ �'------------ -------------------------------------------------------------- Phone--Ho----- 76V------ Installation will serve: Residence �p-artmen+ House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/__ Number of bedrooms ____ -Number of baths ---/-- Lot size -__________________ Water Supply: Public system V1 Community system ❑ Private ❑ Depth to Water Table6.0_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay oam E] Clay F] Adobe `[Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: g � (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) tic Tpnk: Distance from nearest well_________________Distance from foundation--------------------Material-_______________.________________.__._.______- " No. of compartments--------------------------Size------------------------•-------Liquid depth---------- ---- ----------Capacity-------------- -------- D osa�p Feld: Distance from nearest well_�o�__Distance from foundation__.I "______Distance to nearest lot line__ .p 9, t _ Number of lines-----/----------------------------Length of-each line----I----__-__ it Width of trench.aV-��--------------------- � (�dc� Type of filter material_��4------Depth of filter mate rial-__.I�________-_Total length----------1,� __________ _________ Sa • . Distance to neare t well_.__N ____Distance from foundation---Xj_ ......Distance to nearest lot line----- X______ Number of its__-.-_______._______Linin material__&.& Size: Diameter__.J p� g �-------- --- - ------ .Depth-- Z5---------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------.____.Lining material-------------------------------------- 1771 Size: Diameter-----;-------------- - ---------------Depth----------------------------------------------------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well_____________________________________________ _Distance from nearest building------------------------------------------ ❑ Distance to nearest lo+ Iine---------------------------------------------------------------------------------------------------------------------------------------------- P)Vmodeling and/or repairing (describe):_.Mi?s------- V,![ CPD-----OWNS-----80T14-----p1j—=Cj -------C�-�----pyo- -`.OM4-----DV--------Shy-s-------- FtP"r�-�_-`I fl K-S----ARA-•----` '°9± ------'0=- J.A--•-----------------------•-------- ---------------------- -------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance to laws, and rules and'regulations of the San Joaquin Local Health District. Si ned ( g ) Nr"is a `------------------------ i'l---- J� r,Qnd�6oe-Contractor) - --- _: .--�---- - ------- Title---------------------------------------- ---------------------- By:----------------------------------------- - ( ) (Plot plan, showing size of lot. location of system in lation to wells, b ildings, etc., can be placed on reverse side). " FOR DEPARTMENT USE ONLY car APPLICATION ACCEPTED BY----- .R, ---------------------!`--------------------------------------------------- DATE---------- -2'?-- --1------------------------ REVIEWED BY-------------:------------- ----- i -----=-------------------------------------- ------------- ----- - ---- DATE----- ---------- --------------- ------ ---------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ------ DATE-----------•-------------- -- Alterations and/or recomm dations• Z---- ---------�7------------•-------------------- -- 4-1 ----j--/- q1-xV'.P� 3 �$ Q IP : - cel -- -- CoN h!!T- ------- -- ----------------------------------- -- ------------- ----- -- --- --------------------------------------------•------------------------------------------------------------------------- FINAL I TION B Date_-----. --- --2- --` - _---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street i 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9--2M , Revised 1.57 F.P,CO.