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e APPLICATION FOR SANITATION PERMIT ermit No. (Complete in Duplicate) A. q y ;y' T �- Date Issued Applica�ion is hereby made to the San Joaquin.L-ocal.Health.Dist-r-ict fora permit-to construct and install the work herein described. This application is made in compliance with County Ordinance No: 549. df JOB ADDRESS AND OCATI N_..._�_____ v ___ Owner's Name------- ------- Address-_/ Ph n8 _� Address__..!_ . 3�+ �� } -- ---- ----- ---- ------=� -------------� ---------------------------...... --------------------------- Contractor's -------- --- -- Contractor`s Name ----- l L- _ - �_�_____ _ _��------ -- ------- --------;------------------------ Phone ��/ ---`�� Installation will serve: ,Residence ©Nartmenf House ❑ Commercial ❑ Trailer Ciourt ❑ Motel ❑ Other ❑ i Number of living units: _ _ Number of bedrooms __ _ Number of baths J--- Lot size -_s ___14__/_4__Q._-•---------------- I ) Water. Supply: Public system [+r Community system ❑ „Private ❑ Depth to WatJ Table y-17-ft. n` Character of soil to a depth of 3 feet Sand+❑ .Gravel ❑ Sandy Loam ❑ C11.y Loam ❑ Clay ❑ Adobe©�Harclpan ❑ W Previous Application Made: Yes E] No New. Construction: Yes �o .❑ ` T1 10 TYPE OF INSTALLATION AND SPECIFICATIONS:--- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { Septic Tank: Distance from nearest weEl-----mss___.___Distance from foundation---�� Mat real --_"` _. ----------- `5A"- ------------- depth___'i!_�-------------Capacity_--g'S-D_-- --_-• + " k. i t Disposal Field: Distance from nea'resf, welLf`--......Distance from foundation�A.-_.__�---.Distance to nearest lot line.__'s__--___.... [! Number of lines---`--_✓-----------------------Length of each line------Ra_'___-- --:----.Width of french------ 3� ------ T e of filter materia -S� ---- Type �� --fi�_�-�-_.__Depth of filter material,._��P��-------Total lengfh____f�_!�t--------------------------- Seepage Pit: Distance to nearest-w[11_/—------------Distance from foundation__./431........Distance to nearest lot line-47-/-__--- Number of pits......77. t_._______Lining.material__S�6�____Size:.Diameler__--•3A- -__.___Depth-------- S_-I__-- k --------------- Cesspool: Distance from nearest well_________________Distance from foundafionP--------.____Lining material__._.___.._________.___--____.____-_. ❑ Size: Diameter------)------------------------------- p -----Liquid Capacity-------- -------------------gals, Priv Distance from nearest well_________________________ Distance from nearest building--------------------------------__-_____. ❑` ,Distance to nearest lot line----------- ------- -------- --------------.1-1 Remodeling and/or repairing (describe): ----- -----------------------• 1 7 4 IA Y, { 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 fife San Joaquin Local Health District. (Signed)----------- --/---------- - ------------------------------ (Ow ler and/or Contractor) Gtr +r ` ' ----- _ By:--------------- ------ ------• • -------------- ------- -------------•- -• ---------------------- �=- -- -:--- ---------------- -------------------- to - ---•----- --- 1 (Plot plan, showing size of lot, location'of sy min relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------------------ -- ---- - --- ------- - --:- - -- - - - - DATE----------- --------------- ----------- - ------------- REVIEWED BY ---------------------------------------------- DATE---------- = BUILDING PERMIT ISSUED------------------------------------------------------------------- --------------------------------- DATE = Alterations and/or.recommendafions:---------------------------------------- ---•-----------------•------------------------:------------------------------ ---------------------- I I ----------------------------------------------_____---------------------------------------------------------------_--------.--------------------------------.-----------------------------------------.---------- --------------------------------- k ____________________________________________________•__-___________ _ ________________________________________________________________________________________________________________________________________,_______--__---____-________________________,_-._________-___.__.__ FINAL 'INSPECTION BY: `"- "��.� Date - ----- ----- >11!�7------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1300 West Oak Street 132 Sycamore Street .814 North "C" Street Stockton, California f Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100