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V. �. APPLICATION FOR SANITATION PERMIT Permit No. Y___________ �. (Complete in Duplicate) .►'� I, 1 f _�,.��"�/� Date Issued ______'��'-____ -__-Applic' ation 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. 5499..) JOB ADDRESS AND L{{O--��CATION t = (�1=! --._.... •--------------------•------------------------------------ Owner's Name-------------- f-------------W-e— ---------------------------------------------- Phone -92 Address - - { ( '-------- Contractor's Name------------•-•-----------------_tAk-'U'`_tAkA�a.4---- Phone------ Installation will serve: Residence [54. Apartment House El Commercial F] Trailer Court El Motel ❑ Other Number of living units: --- ___ Number of bedrooms .--!--- Number of baths .__/___ Lot size ------- ___C__ ____ ____________ Water Supply: Public system ❑ Community system ❑ Private b Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g Hardpan [❑ Previous Application Made: Yes ❑ No,M: 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----------------------Materia l____-_-_______-_________---_____-__-------_.-- ❑ No. of compartments------------------- ---- iz ------- Liquid depth------------------------ Capacity--------------------- . y/! PiG� -- - - Disposal Field: Distance from nearest well_ _._______Distance rom oundatio -_______-_�-_ c dearest lot Number of lines------------- -- -----------------Length of each line---------'7-P- - -. i rench--------��^ ---r_'-----____-- Type of filter material___!jl,_'_i_{r`Q�Depth of filter material-____ ----------�---__-_Tota length___.__--_-:7- �-^_________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_______________._ ❑ Number of pits----------------------Lining material----------------_------Size: Diameter-----------------------Depth---------------------------------- Cesspool: --------------------------- -. Cesspool: Distance from nearest we#1---J_V____Distance from foundation_--_-�-e---_Lining material_-__ ! - '� Size: Diameter x; Depth - Liquid Capacity ------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________________________.__________. ❑ Distance to nearest lot line------------------ .<-------------------------------------------••------------------------------ =---------------•-------- Remodeling and/or repairing (describe)----------- ---------------------------------------------------------------------------------------------------------------------•------------------------ ---------------•--------------------------------------------•-------------------------•-------•-------•---------------------------------------------------------------------------------------------------------•------------ ---------------------------------------------------------------------•-------------------------.-•_-----------------------------------------------------------------------_-•------------------------------------------------- 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. (Signed) ----------------------------------- - (Owner and/or Contractor) BY:---- -- -------•/ - 6 �~' —°' " ' — ---------------=-------------------(Title)----------------------------------------------------------- (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------------ --X�. ---------------- --------------------------------------- DATE-----0------ REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------,-----------------------•----------------------- BUILDING PERMIT ISSUED---------------------------------I------------------------------------------------------------------rDATE------------------------------- ,- Alterations and/or recommendations:______----- k= - --�c�-_—� ' __------- f : ?iz�C_---_! =-r ------ -n;f3 ---�------------------- "1 J eC - �iC'Fj7 4� ---� }�[ 1 �------ y' �� -•- =- -------r�Lr�rF' _�!/I, r----•R-------- -------------KA-----Z�1_' a.tJ-'� „ti.----- ' " ' e °' • — --------------- --- - ------ ----- ---------------- ------- ----------------- ----- ------------------------------------------------------------------------------------------------------------- ---------------- ------- -- ---- T -- ------ - --- -- --------------------------------------- -------------- ------------------------------------------------ --+per, - C��J FINAL INSPECTION BY------ -- --- - - - - ---_------- - Date------------------------=-------��°- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Worth "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100