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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) IO f Date Issued --..__---- ' Application is hereby made to the San Joaquin Local Health District fo.r,a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. C.'Z- .30_13.41 JOB ADDRESS AND LOCATION_.-. I�fa _-nex_.-A.� JlpO-_.ROd__.--_ -'L Ai. / U /1�1+ . Owner's Name-- Wi11Ma r--•------•-- ----------------------------------- - ---------------- - ------------------ Phone------Lodi--9-s93-58 Address.................. -Bqx 56, -Aeampot Calm 3 _s--- - --- ---------- fa :---- -- Phone Contractor's Name_...- �- ' dill employ_ others to do aca1_work. Installation will serve: Residence :E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1.---- Number of bedrooms -...4. Number of baths ----2- Lot size --------------------- Water _Water Supply: Public system ❑ Community system ❑ Private M - Depth to Water Table .'.6oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No E5t New Construction: Yes ® No ❑ Addition to old Construction. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I -� W 1 Septic T k: Distance from nearest well---__b6------Distance from foundation___1_0----------.Material.---Corwrete---------------------- p sen}Nf.___41_x5® Cono. of compartments------- -- Size_- Liquid de th----- R---_---------capacity x35---CL . Disposal Distance from nearest well - Q5:0-.-Distance from foundations-.la---_-_--- Distance to nearest lot line--------519"Z Number of lines...._.......2.............. phi of each line._ _ f �7{ �- -- -��..��rWridth of trench---•---3---;U-t------------- m ��fir Type of filter material-r� k... .D p h. of filter mate ria 11? length------------------------------------------ C Seepage Pit: Distance to nearest well ...._______:--------Distance from foundation---------------------Distance to nearest lot line...___.--._--_ ❑ Number of pits----------------------Lining material------------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-..._._____-.-.Distance from foundation-_-----------------Lining material__..--.---.----..-_.-------.._.____--. _ ❑_ W::- _�_.T.. ,,Sizes- Diameter---e_ - ------- --------------------- __ _---._ Liquid�Capaci.tY - ---------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--..____------._.....__._-_.---.------... ❑ Distance to nearest lot line----- ------------------------------------------------------------------•---------------------------------------------------------------------- Remodeling and/or repairing [describe):-..Neer-- -con s__tr�rction consists of-- f _additional leaching lines a-s present lines ar_ e only about 201 long. n add�:tion connection off'---iljies t-o drain �1 ash•--tub water---nc1---kitchien---sunk---v�ater wi11_-b_e----addedi s lndleat6a-- to--tfi®- -- ------------•-------------------•---•------_---------------------------------------------------- ---------------------------------------------------- ------------------------------- ex stirs p-eTtic tank. New construction indicated on---c---h---a--r- t in ink. ---------------------------------•--•-------------------- 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. (Sig p ed) .._...... - ------------ ---------------------------(9! epnd/or Contractor). `sy: i..- ------------------------- (Title) ovnr . - --------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- -------------------------------------- DATE----- - REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE--------------------------------- BUILDING PERMIT ISSUED--------------_-------- --------------------'-------------------------------- ------------- DATE-----------..--------- - Alterations and/or recommendations-----------------W`-- ---------------------------------------------------------------------...--------------------------------------------------•-------------- ----------------------------------- --------------------------------------------------------- ------ -•-- ---------------------------------------------------------------------------------------------------------------•--- ---------------------------- -------------------------------`--------------------- -----------------------------------------------------" b----- =1NAL INSPECTION f G1 . -- --------- Date.... l - S ---- 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