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APPLICATION FOR SANITATION PERMIT Permit No.A_Vk-S�-- liDli (Compete n upcate) p Date Issued _ __s�-��-Y t 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION '------------------- ---- --------------------------------------------------------------------------------- Phone__3.7-974 7----- t -- Owner s'Name------------�'-•---��s�--� --------------------------------------------•--------------------------------------------------- Address ----------------- - - -------------------- --•------------ Address---------------•-•----== 41.6 -Bri--�0-7.-----------------------------------•----------------------------------------.....-•------------•------• -------------------- ----------------------- Contractor's Name-------------------D_ r,,tD ----------------:----------------------------------------------------------------------------- ---------.... Phone.------ Installation will serve: Residence ❑ Apartment House ® Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unit-9: ---3___ Number of bedrooms ----3__ Number of baths ___ ._ Lot size _5-01210 Water Supply: Public system-`Q Community system ❑ Private ❑ Depth to Water Table ________ ft.. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan 0 Previous Application Made: Yes ❑ No ® 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--------------------Maferial---------------------------------__--------- N o. __._____No. of compartments--------------------------Size_-------------------------------Liquid depth--------------------------Capacity------------- ---- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line--- ------------------- .________.F_ ExIS'-141 0"G Number of lines-----------------------------------Length of each line------------------------------Width of trench Type of filter material-------------------------Depth of filter material------------------------Total length----------------------------------------.- Seepage Pit: Distance to nearest well------_-------------Distance from foundation-----4!----------Distance to nearest lot line------- 41' )E] Number of pitsl-_____--_._______Lining mate rial:_T)r_J :------Size: Diameter_--_�ct______________.Depth___- -- __�. i Cesspool: Distance from nearest well_______________-Distance from foundation__________________.Lining material___________-_-____________-____— ❑ Size: Diameter.' --------_-Depth--------------------------=-------------------------Liquid Capacity----------------------------9a Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________-_-___________-..�- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------- --------------- •-------- the Remodeling and/or repairing (describe) t, 'r1 n -i f1 -1 l �'+ ____________________________________________________ ________________'____P______ CCC _- _- .__ �=c- �=�'U---• .-_-.cam--�r-, _..--- �-s------_.._.�� -------------------------------------- ------------------------------------------------------------------ ---- ----- s' ----------------------------------------- --------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signedl-------•--....----I?u L ty-------------'----------- ----- --- ---------------------------------------•----------•------ ---- (Owner and/or Con 0 - t �. - � �' ,,pp:! I --e_ -N o tra�.-f - ----------- (Title) _= g . Jere _r'I2.r�_3 - - (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY__<7�-----------_------------------------------------------------------------------------------ DATE_-------------------------------------------- t REVIEWED BY------------------------------------ -----------------------------------------••-------------------------------------- DATE------- y ------------------------=------------ LT BUILDING PERMIT ISSUED----------- DATE ----------- -- - EAlterations and/or recommendations:--------------------------------------------------------------------------------------------------:---------------------- ---------------•---•----------------- L. . _...- - --------- - - ------------------------------------- ------------------------------------------ 1 f Date_.-_..__ - -------------- ------ FINAL INSPECTION BY:-------- :y ---------------- -•-- --�-------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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 8-51 Revised W-2100