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Permit No. Y_OP.3----„�„—, .,;.r,-.APPLICATION FOR SANITATION PERMIT � 91 (Complete in Duplicate) pate Issued'?A..s�``'�'--� Applica+ion is hereby made't&'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---- s - - ----- _ s_ -•-------�-a-----�-----��------�----------------- ___________________________ •-------------------• -• Phoe--- Owner s Name--- ---- ---- - -.-- ................. -- - ZT Address--- ------•-- } F one d Contractor's Name__. - _ •-•-------------------•--------••-:------•-•----._..... Ph # --- - Installation'will serve: .Residence Z -Apartment,House ❑ Commercial ❑ . Trailer- Court ❑ Motel ❑ Other ❑ Number of living units: _I___ Number of bdrooms`:r ____ Number of baths __L Lot size______________ _ ___ _a _.________ ________._-__ Water:5upply: Publicksystem Community system ❑`�Pridate ❑ Depth to 1Alater`Table � -'f#. I -_ I Character of soil to a depth of 3 feet: Sand ❑ I Gravel El ..Sandy Loa ❑ Clay Loam ❑ _Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes D No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: � r No se tic tank'o ( p r cesspool permitted if public sewer is available ithin 200'feet.), I - � J Q____ ___________ __'__ -_____. eptic Tank: Distance from nearest well_�_I_-- ___-__Distance from foundation __-____-E______Material_________ . .. No. of compartmen#s-.__N=1------ ----Size---•------------------=---------Liquid depth------•--------- --------.CapaeitY � Li. �- ---______:Distance to nearest lot line__________-lv� �...- Disposal Fi Id: - -Distance-from nearest welL._Q� Di tante from foundation._ Number of'lines = ' _ 1 Length of each line__A Q”1_ •Width of trench---- - ----- -----------• e r T e of filter material__Si_lF V- Depth 6f filter material------ - ��_:_____Total length___-_ d_____________ YkYp Pi#. -, Distance to nearest:wgll �___NaAW©istance ro fm,rfoundation-------- Seepage ..Distance'to nearest lot line._s________ r .r Number of pits:-- ' R/ ' Lining jmaterial= _ _____ - '--Size: "Diameter_----,,: .� -----_Depth utcs��___--- ---__--- 1 s. S i ------ Cesspool: Distance from nearest weiL ______ "_.IDistance from foundation lining mateeial______________------------ ❑ Size: Diameter- ;� }-^"� Depth - _ `Liquid Capacity----•--•---------- - ----gals. -- - - ` ' --- -_ ___-__-Distance from nearest building_ --. -------- Privy: Distance fro"m`nearest wail__ --:- - _;: *. "" ------------ - --------- El Distance to nearest lof-line4_�_ _______ Remodeling;and/or.-repaHrig'(describe)-----`------- T - - ------ r ---------- -------------------------------- 4 '_______________1_..______-..____..-______.....-________._.__._...._____—______________________-_-. ___.___-__________________ ____ t p. -y i ________________________________________ ____________-________-.____-_-_._________-_______.______-_-____________-_______-__________._______.»._____....__..._______________ I hereby certify that I have prepared this application and +hat the work will,be done in accordance with San Joaquin County ordinances, State laws and rules and reigulations of the San.Joaquin Local Health District, r - } T� [ 'ner and/or Contractor) ort -Si i - --------------------i ---------------------------=--------------- ---------------- By -------------- ------------------------------------ -[Tit e� (Plot plan, showing size of lot,location of sy'st�m in rale+ion to wells, buildings, etc., can be placed'on reverse side). x FOR DEPARTMENT USE ONLY { I APPLICATION ACCEPTED BY-------•--- _ ----------------- -------------------------------------- DATE DATE__�-----�---r�---�f-------------------------- REVIEWEDBY---------- -- ------------------------- -------------- ----------------------------- BUILDING PERMIT ISSUED - _ ------•_---------- -DATE -••---- , - Alterations and/or recommendations:-----------------=----:-------= - --- = ................-.......=---••------------------..................= -- - ; ----------------=---------- ----------------•-----------------------•--•-----------------------••-• - - 1 - _ .________--________________._____________..._________.__-_ i _________________________________-.- i t ___________________________________________________________________________________________ ________________________________________________________________________________________________ 4 ________- _____________________________________________________________________________ _ lop !' 7 ,._ .,. _ ,... �w ------- -- ----- -- -..--.--:-------" FINAL 'INSPECTION.BY,..-,/'- Date. i 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 k. ES-9-2M i Revised W-2100