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V E � APPLICATION 1=0R SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _____ Applica+ion 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. 549. JOB ADDRESS AND LOCATION-------29-67---- MKInl-eY---.......--- --------------------------• --------------------------------------------------------------- Phone -- 2-056`6 Owner's Name !Tames----- ---L e e-� ------------------- -------------------------- Ho. Address 2S_2..W. ZVy---------- ---------------------------------------------------------------------------------- Contractor's i Name------`----------------------Delta �-1269 Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.❑ Other ❑ !Number of living units: -- _-- Number of bedrooms __2__- Number of baths ___Z__ Lot0size ____-- .15 C____._------------------------------- Water Supply: Public system ❑ Community system ❑ Private [:T, Depth to Water Table's 0___ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ . Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ -No © New Construction: Yes [Z No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) } _ . .t_- Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------;____--__. exis112rii, No. of compartments--------------------------Size--------------------=-----------Liquid depth_---------------' 'Capacity----------------------- f Disposal Field: Distance from nearest we€i------------------Distance from foundation_____------------__.Distance.to,nearest,lot line__-____-----____. exisI ng Number of lines-----------------------------------Length of each line---------------".--------------Width of french----------------------------------- i. Type or fitter material-------------------------Depth of filter material.-_.------------------Total length--------.-----------------------.- Seepage Pit: Distance to nearest well--------- _Q�___- _Distance from foundation.._..............0 ..... to nearest lot line-----5__1_____ [2 Number of pits-----------I-------Lining material____bT'1.Ck...Size: Diameter___.____.31____.__..Deptn___"�----/ _.2e Cesspool: Distance from nearest well-----------_-----Distance from foundation---------------------Lining material-------------------------------------- 4 ❑F e: Diameter--------------------------------------Depth------------- _A quid Ca.pacitY - = - - 'gals. N YPriv T"� D stance from nearest well_____________ .-- __ ____ __-__ ___._.__Distance from nearest building ❑ ; .. _ .... Distance to nearest lot line--------------------------------------------- --------------------------- ----------- ------------ ---- 1 Remodeling and/or repairing (describe):__________ad1ing_yrts � � Sytm ------------------------------ n ___ --------------- •-••-------•------------------------ �' ------------------------------------------------•-------- ---------------------------------------••---•------------------------- -------•--------.........------------------------ - - - ------- ----- ---- -------------------------------------- ------- ----------------------------------------------••-----•--------------------•---•------------------•-----------------------•---------------•---------------------------------------- I 'hereby-certify that l 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. 1 --------------Owner and/or Contractor (Signed)-----------------------�+~ ---------------`---------------------------:=--------------------------:---------�--------- --- - -- --- { / I P.W. - - Ti+le 14gr. `s By:... ------- - { ) '------------------------ ---------------- -------- (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 A----••-------------------------------------------- REVIEWED-BY------------------------- DATE- fi DATE ----- BUILDING PERMIT ISSUED-------�-��-------------•--------••--------------------•---=---------= -------._... ---------- ------�----- ---- ------------ Alterations and/or recommendations:_________..________ ___________________ -------•------------------------------------------------------------------------------•---------- ----------------------------"--=---------------------------------------------------------------------------------- . I ________________________________________________________________________________________________«____.__________-___________.______._.___--___...___._-__.____--_-----__.____..____.____.___-_------R.___..-. ----------------------------- -----,---.----------------------------------.-----------------------------------------••-•-----_---•--------------------_---------------------------!---_ _-___-_•____..__•__•________ FINALINSPECTION BY:-"------- -- ------------------------ ----------------- Date -------------/ -- --------- ------------------------------------ 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 1