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\�S APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate), Date Issued -----------d--_S - ----- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to const�ct and install the work herein described. This application is made in compliance with County Ordinance No. 549. --------"---- -- - - - ---•-- ----..- / .1 < = ' ------------------------------------------------------- JOB ADDRESS AND LOCATION_ A Owners Name----------- fG yA ' _. hon , Address------------ 'D i-------- --------- Phone Contractors Name------- C,C/�l`_ - � ----------------•---------------•-------------------------- 4 - --6 ..Z_ Installation will serve: Residence [ Apartment House, ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: _---_ Number of bedrooms ._ - Number'of baths J__ Lot size -----f _.x_1_O:...- 1 Water Supplyi—Publiclsystem'9 Community system_'.❑ 'Private E] - Depth to Water Table S-b ft.. , Character of soil to a depth.of 3 feet: 3 Sand E] Gavel [ISandy Loam E] Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction:'Yes ❑ No TYPE SOF INSTALLATION AND SPECIFICATIONS: f (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) r __ Septic Ta k: ist nce from nearest well-----------------Distance from foundation--------------------Material_--:-_-_I__._.-----_---------_.----- ---------- ❑ N . of compartments---------- --------- --Size---------------------__.--------Liquid depth--------------------------capacity----------------------- ; .. . . . . ; umb oflines____________________3_.______-__--±Length of each line___:._.____--__----_- Distance to nearest lot line__..__:_________. P '----.Width of trench----------------------------------- Dis osal Fi d: ante from nearest well--r---- f � ❑ ' - --. _Distance fromfoundation rnateial ____•-'-----____---Total length ` Type of filter material---------- -------------Depth of filter 9 ----------------- _ Seepage Pit: bistance to nearest well--- _. .__.__'Distance from foun4at,on---__-4Q..___.Distance to nearest lot line--------------- Linn aerial--- - �-- , ' meter_____ Depth ------------ -_`_�---'-- -_---- -�y� ��.,•_. ,. �Nu�mber of pits.-'----I------------. ig m_ � tDia6 Cesspool: Distance from nearest well---.--............ Distance from foundation.---_._.___._._...Lining material------------------------------._----_. ❑ Size: Diameter-0------------------------------------Depth----------------- -- ------- ------ ----.Liquid Capacity- -----------------------P--gals. Y Privy: Distance from nearest well.---------'------------------------'- `--: .-Distance from nearest-building------------------------------- ----- --'—Distance to nearest)lot'line__;""___:------------------------------------------m Remodeling-and/or repairing.ldescribe):----------------------------•----------------•-•--------:--- ---------------------------------------------------•---------------------------------- -------- -------------------------•----------------------- 1.4 = - -k - Y ; ----------------------------- __-- ----------------------------------------------- ---r- ----- _------__-_--_.-_-----------------------------__-____-_.-_____--_____-___-----____-.-----___--. + tY - # --------- ---------------------------------------------------- -... -------------------------------------------------- ----r----------------------•---•------------------- Phereby 3 certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, Sta a ,' and rules and regulations of the San Joaquin Local Health District. - . ------------ - -- "�~CJ---------- �--------------------------- ---------------------(Ow and/or Contractor) ' f (Signed). 1. �. / ) / y _ ------------------(Title)------- c I"By:-f_ -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- ------=------------ ------------------'--------•---------------- DATE-------�------------------------------------------------ '>,-,� --- ------- DATE----�9-------i-----------•-----------------•------- REVIEWfED BY n - •----'------ ----------------------------BUILDING PERMIT.ISSUED ---=------------- - ------------------------------- DATE------ -\Nr re mmendations: w _.Alterations and/or ..-----...----••-'---...:-----� ------------------------------------------------- l 1✓ L/ -------- --- ---- ------------------...____.________.___-__-_-_�.._____________. _______.---.__.___.__._.______ _____.._.___._..--_...___ '---------------------------------------------------------. _______-.. S1�. .FINAL INSPECTION WBY.:^�-`--_-..- ---------------- '. '" _ 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 ES-9-2M Revised W-2100