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JL APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) D • Date Issued �pplica-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 N 549. ! 'r JOB ADDRESS AND LOCATION--------... �- - ---� --------- -------r.----.__Y._YsL�2_ - / _. -v--'•A•------�.�--/-..--F'./Y-<. ----- ----------• -- Owner's Name__________ _ R__ // Address------------------ - ` s�'' �l r1`�1E1 � /7 ------- ---•----I------ Phone ��': "_!_KC�.-� Contractor's Name______________________________ __ Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel E] Other El_!_ F Number of living units: ____ Number of bedrooms Number of baths J__--- Lot size -3-2,07y___/--, . ----------------_------- Water Supply: Public system ❑ Community system ❑ Private Igg—Depth to Water Table _6V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan,❑ Previous Application Made: Yes ❑ No)g�_ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C t , k' Septic Tank: Distance from nearest�well_+40__,_____Distance from foundation---/Q___-___.Materia I_-CTS_ ______:.� bA No. of compart Fents_-(�` Size. ?sf✓,j� ,�'A Liquid depth-_.,$2 __.______'_ Disposal Field: Distance from nearest w0___4__V-__.._Distance from foundatio '4c-n__• L',._--Distance to nearest lot line_____ Numbe` of lines__ ____________Length of each line----- .__ _Fi--____.Width of trench- Type or filter materiaLI-�__tZf�_�/�rDepth of filter material___ If,--------- length_________- Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line__________._____ ❑ Number of pits----------------------Lining material------------------- ie: Diameter.----------------------Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.---------------- Lining material__--------------------------------- 0 ____.______________._____.__ -_❑ Size: Diameter---1---------------------------- --- ----------------------------- ------_---Li Liquid Capacity------------------ -,-------gals. - ---Depth-------------------•- - - ------------ 9 ff 1 I, Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building----------------------I--________________ ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- ( Remodeling and/or repairing (describ ----- -- � ....... .......... t ------ ------ -- ---- -------- ------- ------------------------------------------------- ---- s -- •• - - - �- ------ - - --- ------------ -- ------ ------- - • -" -"-- --- - ---- -- -Y ----- ---- ------------------------------•----------------- - - -- ----------------------------------------------------------- -- --- --- --- -- ------ -- - ------------------------------------- -------------------------------------------------------------------------- -------------------------------------------- --------.-------------------------------- --------------- I hereby certify-f"6 I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, fid rules and .egulations of the San Joaquin Local Health District. (Si9 - - - - - - - ------ --- ---------�--------- ------------------------- - ---Owner an r Contractor] ---- -------- ---------------- By:------------------------ ----------- ' , ------ .(r+le)....... y� (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be pla$e on reverse side}. i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------------- ------------------ DATE-----------, REVIEWEDBY --------------------------------- --- - -___ " ------------ DATE---- -----------------------------•----------------------- BUILDING PERMIT ISSUED = ,' ` ------------------------- - DATE------------ Alterations -----Alterations and/or recommendations:A----------u :- A , 'r--------------------_ ---.--------- _ - ----------- 2A--- ----- -'- --- !—--fit 1x-;---- .-_—T .red- ------- _!9°-_ -.----� ,i �� -----------------------} --- ----------------------------�-... 1 ----------- _1_--- `r'� y j y � y• '- F .n �S d_ - ! Y•�4 yq� 'L S� +---- ,a. .. 't -- ----- - __.._.a Cry, , � - ------------- ------------------------- -- FINAL- INSPECTION BY:..��._- ----__` ' Date---------- - ---- ------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300.Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M - Revised W-2100