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-'iA \j APPLICATION FOR SANITATION PERMIT j l'Tte it No. 9011 (Complete in Duplicate) �` "+ Issued Ir Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and Atall the work herein described. Tltis application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI -----------gv---�-------------- - ._---------------------------- Owner's Name_\,____ J--- :'r L. ------ t�1.Q �r�------- Phone--------------------------------- 57 7'0 Address - - -------- - ----- - — ---------------- --••-- - --------- Contractor's Name----_-..._--- - ---- Ph -- ------------- Installation ------ --- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/._ Number of bedrooms 0._ Number of baths -a2 Lot size —A7 ---------- Water —_ _Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table y ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ j Previous Application Made: Yes ❑ NoNew Construction: Yes< No ❑ PE TYPE OF INSTALLATION AND SCIFICATIONS: l t , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well J14 Distance fr m faundation__l--d_._____.M tenal_�_-_.�_____'___ No. of compartments----- ---.---_- -- Size---- - - ___--Liquid depth-- d2------------Capacity--- Q Disposal Meld: Distance from nearest well/l,�__Q_r__Distance from foundation__r.R_4......-Distance to nearest lot line...... Number of lines_____ .�________ ____Length' of each line__3Q____ _.__ _.___.Width of trench_ ___ Type of filter material-_ ✓_ lJ 43Depth of filter material______x_22----------Total length- Seepage ength.Seepage it: Distance to nearest well/6_0-.__---_--Distan . r m f ndation____ ._ _. __.Distance to nearest Io line__ --------- Number of pits_____..-----------Lining material �� _.Size: Diameter'3_�----- ---- Depth__ S-------------------- ' Cesspool: Distance from nearest well_________________Distance from foundation____._.------------Lining material__.___.__________.____________--_____. ❑ Size: Diameter------------'.,-----------------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance-from nearest well----------------------_--------------------------Distance from nearest building------------------------------------------ kA - ❑ Distance to nearest lot line------------------------------------------------•------------------------- -- ------------------------------- --------- Remodeling and/or repairing (descri el:----- -- --_�_ _��_ __�. t/ ---•- ..... i f ------- -------------------- ------------------- -� -----------------------------------------••--------------------•------ •-------------------------------- _ ________ _________f______________________.-____...._____.__----________________-4---------------------------------------------------.------------------------------------ ___________________________________ -------------------------------------------------_____---------------------------_________________________________________________________________________________________________________ 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, aad rules,and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed) ----- , - / ) a /j f - By:.....-----•-------------- = f "'� -- -<rz�' -'----------------------- (Title) (Plot plan, showing size of lot, location of system in retation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY :., . ------------.---------------------------------------- DATE--- ------------------------------------------------ REVIEWEDBY---------- ------------------11;--- --------------------------------------------------------------- DATE - -------------------------------------------- BUILDING PERMIT ISSUED - DATE.. ------ - - Alterations 4d/or recommendations______________ •---------------------------------•-----------------•-------• ...... .._.-..----------------------- r _- --- --- : ::R� - ::.... �s --------------------------- �-•� , 2 J ---------------------------------------------- �('� �"� Gi'' -------------------------------------••------- v -------------------------------- -------------•---------- --------------•------------ ----- FINAL INSPECTION BY:-.--------- ------ --------------------- Date---- -----)----'------ - --------------------I----------_-__.--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ' Revised W-2100