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q` Permit No. 7 APPLICATION FOR SANITATION PERMIT e � (Complete in Duplicate) Date Issued )6Application 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. n JOB ADDRESS AtKD LOCATION----Z�f ,6 ----- � YE ----- Owner's Name__09__ --------- ----------------- -----------�-�----------------.--_-----fPh!o/nVe�_I_Q��N�—pL7J ---_-_--- - . Address---------------------- _V VI Sfl------Ay --------------•--------------------------------------------------------------------------- Contractor's Name__- !7 f 'S- --� r------------------ Phone_-Y=------�_�!_. ------- i Installation will serve: Residence ❑ Apartment House ❑ Commercial V Trailer Court ❑ Motel ❑ Other ❑ 1 s Number of living units: Number of bedrooms ___-r- Number of baths ------- Lot size _1Q---- - cBQ------------------------ Water Supply: Public system ❑ Community system '❑ Private_W Depth to Water Table-ST- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ISI, Hardpan E] Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: • (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_______,______Distance from foundation--------------------Material----------------.__-_________------__--___-f____. ❑ No. of compartments--------------------------Size--------------------------------Li uid de th--------------------------Ca acit q pp Y---------------------- Disposal Field: Distance from nearest well__�Q`-_-_.Distance from foundation___,�24_Q__-__-___-Distance to nearest lot line___A9�___. '� • Number of. lines-----Q/ y-;�- ------------Length of each line---- ---------- -----Width of trench _ _, ---- - ---------_--_-------- Type of filter material_ __�g�K__Depth of filter material__A rr_--______Total length----- Seepage Pit: Distance_ to nearest well________________.__-_Distance from foundation------__------------Distance to nearest lot line----------------- F1 Number of pits----------_---------- material-----------------------Size: Diameter------------------------Depth---_----------------------------- Cesspool: Distance from nearest well-______________Distance from foundation-------------------_L'sning material------------------------------------ El -_-_ .-----______________________-_❑ Size: Diameter----------------------------- --------Depth---------------------------------------------------_Liquid Capacity------------------------_-gals. Privy: Distance from nearest well-------------- ----------------------------Distance from nearest building----------------------------------------- rw ❑ Distance to nearest lot line-- -------------------------------------------------------------_-------------------------------------------------------------------------- 4 ,. Remodeling and/or repairing (describe)=----eii.f?= s - - --------------• •-----.- -� ;a,cr�-__--- ` -----------•------------------- --------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, andrrules aridaregulations of ;he San Joaquin kcal Health District. ' r {Signed} - i..� -----._r_ . ------ (Owner and/or Contractor) sY� _! --- ---- ---- ----------------- (Title} (Plot plan, showing ee of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------— --------------------------------------------------- ----------------------- DATE--------------------------r -------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE--------------------------------------------- -------------- BUILDINGPERMIT ISSUED-----------------------------------------------=------------------------------------------------------ DATE-------------------------------------- --------------------- Alterationsand/or recommendations---------------- ------------------ ------------------------------------------------------------------------------------------------------ ------------------- -------------------------------------------------- -------------------------------------------------- -----------------------------------------------------•------------------------------------------------------------------ --------------------------I----------- ----------------------------------------------- --------- --------------------------------------------------------- ----------------- ----------------------------------------- - ------------------- ------ - ------------- ------------- ------------------------------------------------------- ------------------------------------------------------ FINAL INSPECTION BY:--------------- ----- -------�---' ' "------ Date k 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 1 ES-9-2M 8-51 Revised W-MO k -