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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplica#t) Date fssu d __ _-_!��... Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and instali the work in described. This application is.made in compliant ..with County Ordinance No. 549. JOB ADDRESS AND LOCATION___ -:54-9 _ 14 i•► Owner's Name------Aqpek oll "" � I� iM Phon . Address-------_--------- u. W..... _ " -------- - , Contractor's Name ��!l"r�+sE,e.r' -----------------------•---------------------------------- Phon€011P---4_._0`61P7_- Installation will serve: ,Residence ok Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�__ Number of bedrooms __yNumber of baths __/_. Lot size ----�/--._-A____�_�_rQ'+___.______________.• Water Supply: Public'system Community system ElPrivate E] Depth to Water Table Wig ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ Previous Application Made: Yes ❑ No)c New Construction: Yes ❑ No 041 0144 ., OA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well------------------ from foundation______________~----Material______._______.__.______._____.____.._-________. 6WOV No. of compartments--------------------- ---Size-------•-------------_:-----:___Liquid de th--------_--------. Capacity Dispo al ield: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----:_______--._. _ , !OI9 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type ----__--------------------__ -Type of filter material---_-----_---------------Depth of filter material____.___._____.___,____Totallength----------------------.___________-.______ l� I r Seepa a Pit: 1 Distance to nearest well_ Q_ ! _ Distance�f fo ndation___� ._.___._.Distance to nearest t line___ .p°—__ Number of its_ l ______________Linin material________ __.Size: Diameter___ _ ___ p ' �_____________ ' p / 9 ��'��- ,� '� -_... Dept _ 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---------------------------.____________--. ❑ Distance to nearest lot line - - " =--------------------------------------'=---------------------------------'---------------------------------- Remodeling and/or repairing (describe):_ :____________________�___-_____ d + --------=------------•------- -----------••-•-•---------------•------------------------- -- r i + 3 _. ________________________ ____ _______________________ ___________ __ __......__________________ _________________________________________________________________________________________________________________ _ I hereby. er fy,that I hay repare t is application d that +he work will be done in accordance with San Joaquin Coun ordinances, laws;ar�! rul and reg tions of the n Joa in Local Health District. . (SI ned ~� v�w y" 9 )------ ------- ---------------------------------- - - -------- ( Contractor) By:------------------_ . I . ic ((Plot Ian, showing size of lot, location of system in relation wells- buildin s tc. can bele)la �� P 9 Y _g .p --s d on reverse side). ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- f------- - ---------- ---•--- -------------------------------- DATE REVIEWED BY ---------------------f- -- ------- --------------- DATE '- 4� ------- -- ------------------------ BUILDING PERMIT ISSUED $: ='---------- 1�-- ---------------------------------- ------ DATE Alterations and/or recommendations:-------- ----------------------- -------------- ------- --------------•----------------------------------------------------------------------------------•----------------••-•---•-----------------------.-.__._..---------------------•-------------' ---•--------------------------------------------------- -----------------------------------------------------•--------------•------------------------------------••-•------------------ ( ------------ ----------•-----------•---------------=---------------------------- ---------------- -------- -------------------------------- FINAL INSPECTION •BY:--------------- (�`� Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; - Revised W-2100 If