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SANITATION PERMIT Permit N APPLICATION FOR SZ o (Complete in Duplicate) Date Issued 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 wiiji County Ordinance No. 549. l7{-_/72-23 i-Ft2-1 F - A- '11)� JOS ADDRESS AND LO ATEONi: al;?�"H_Sl.� .a / �/ �Q� --------- ' --------------------------------- Phone /e1,99A_CfS---71 Owner's Name___:�To- -<1Y-----•-- --x-`-----•-4, r-` z '{ �- ` &e:_ Address------------_--/-•-Tpz ZeINIl R_1'------ -----------------------_-------------------- -- --------------------------------------------- Contractor's Name------ .t _1 - -1 ._ /---------------- ---------------------------------------------- Phone ... . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __�___ Number of bedrooms .Number of baths I----- Lot size __,1` --------------------------------- --- . Water Supply: Public system ❑ Community system ❑ Private YK Depth to Water Tablek�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,j Hardpan [] Previous Application Made: Yes ❑ No 54 New Construction: Yes K No ❑ (V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) {fi Septic Tank: Distance from nearest well-o3V-____-.--Distance from foundation_..1.�-___..Material_____ _ ________ ________ ________.._. No. of compartments____ _____._- Size _�P__. _�i+_____ Li uid de t 1 �� Ca acjt �4'� 6', /_ r � . Dispos I Field: Distance from nearest well__1?i-----Distance from foundation,, _-____.Qistance to nearest lo} hre___..___•_____._. Number of lines___�______ --- ----------Length of each line ______ Width of french ------- or--- Type of filter material_ .____ Q. '�-_Depth of filter material__19-----------_Total length------ ---______________________.__ Seepage Pit: Distance to nearest well_____14��._-__Distance from f ndation___. __..Distance to nearest lot line_sw�_.______-_. t� Number of pits_40 `�'�+--------Lining materiiaL_-fes[-i ...Size: Diameter-_.4,1_-----.___.Qeptn_, o. �'s----------------- Cesspool: Distance from nearest well_________________Distance from foundation.------------------lining material_----------_-._________.__.__--_- ❑ Size: Diameter------------------ -------------------Depth---------------------------------------------- -----Liquid Capacity----•-----------------------9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot ----------------------------------------/ - -- ". Remodeling and/or repairing describe):__-_ -" ---- ---------------......... / ....... -------*/ ----- - ---- ------ --------------- ! ---------------- ----------------------- V --------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1-hp-v repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws rule and regulations of the San Joaquin Local Health District. --- ------ -� � V-! Contractor) (Signed)----------------------•--- ---- ---- � � -- - - ----------- ---- - -I ----- -----------------------------------------------� s '� Title I _ _- . sY� ------- - •--- - ---------- ---------------------- -( ) - ! )�' (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc., can be pla&,Od on reverse side). FOR DEP TME, T USE NLY APPLICATION ACCEPTED BY_______________"_ . �'� �f�' DATE------ ..3----- - -------------J- REVIEWED1 BY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------- ----------------------------- -------------- Alterationsand/or recommendations----------------------------------------- ------------•-------------•-----------------------------------------------•---.------...----------------------------- ---------------------------------------------------------------------------------------------------•------------------------------------------------------ ---------------------------------------------------------------- ------------- --------•-----------------------•-----------------I--------------------------------------------------------------------------------------------------- --------------------------------- ------------------------------------------------ ---------------------- ------------------------------------- ----- ---------------------------------------------------------- FINAL INSPECTION BY:----------- ------------- Date l - `�- --------------------------------- 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 10-52 Revised W-2100