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APPLICATION FOR SANITATION PERMIT Permit Noa_14___6....V._ ''' �^ (Complete in Duplicate) 2 �k y y Date Issued 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 Counntty Ordinance No. 549. JOB ADDRESS AND LOCATION-------�_�_S?_----SO__1(fWF_&A 1310 Z"ic4tprt Owner's Name.-------------------------------•------ `� ---------- _--J-------------- -------------------- Phone-Ale Address.- Q• �7- 9- loaklan------------------------ ----- - - Contractor's Name-----------------------------•- ��1-� '"�" +7Q_!'� y 1��7C•-----•--------------- Phone_19+-Fic_0-7------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [ Trailerf` Motel F] Other* Number of living units: _� Number of bedrooms Number of baths k .' Lot size ------------ © � Water Supply: Public system 3( Community system ❑ Private E❑ Depth to Water Table AV- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [y Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: rr (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tnk: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- 15*,K�05 fj17 a . No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-----------------------1 JW Disposal Field: Distance from nearest well_ __Distance from foundation---JQ__----------Distance to nearestlotline____:?___ _ 04 Number of lines_________;tfLength of each line-----'*"�_Q Width of trench--- �i----------_----- Type of filter material_I��_____ -_-____Depth of filter material___a�_4-____________Total length- -_________ ----------------- Seepage Pit: Distance to nearest well__JbftR____Distanc fr m foundation._ Q_ _____.Distance to nearest lot line line__---�____-___ Number of pits---J�----------------Lining material/ eit ----Size: Diameter_.__��df--___.Depth__j-H_`______________--____ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0- 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):. V 'We ----•----------------------------------------------------------------------•--------------------•-----------------------•---•--------------------••----------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------ hereby certify AP have prep red this application and that the work will be done in accordance with San Joaquin County 1 ordinances, :Atews, rules and egulations he San Joaquin Local Health District.(Signed)-- RRI-�- `f------- Qn - r ( L Contractor) C � By------------ -- ------- -- - - --------------------------------(Title)--- x� __# 1 Q ►J t '�--�- (Plot plan, sho size of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- DATE ----- -- ----------------------- „- REVIEWED BY------------------------------------------------------------------ ------------------------------------------------------ DATE------- ------ ----��/- �-z-�------------- BUILDING PERMIT ISSUED---------------------- ---------------- ---------------------- ------------------------------------ DATE Alterations and/or recommendations--------------------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------•----------- ----------------------------------------------------- ----------------- -------------------------------- ------------------------------------------- ---------------------------------------------------------------- l FINAL INSPECTION BY: --------"----------------------------------------- Date--------------` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I ES-9-2M 8-51 Revised W-2100