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r 3 APPLICATION FOR 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 ein d cri�e This application is made incompliance with County Ordinance No. 549. ' JOB ADDRESS AND LOCATION--- Owner's _---t_R.s=pF--9---,.-yq---------- Owner's Name ------Al r--I,-�(-.------. 1�--aIV ------------------------------------------- Phone ------------------------------------ Address d �'� C�pOHf�`'-0NLL�c `�----------------"�O.,D/_-_- C_c__..- Contractor's Name----------- t .�`_ �. _�7._------- /il(,�`;-------------------------------- Phone.= _ . ....... Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ r i; Number of living units: _j_____ Number of bedrooms Number of baths _f_____ Lot size--�_)C_/,��..�__________________:_____.__-- Water Supply: Public5system E]Community system ❑ Private Depth to ��nn Water Table `7� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�4 Clay Loam ❑ Clay ❑ Adobe j Hardpan ❑ Previous -Application Made: Yes ❑ No: New Construction : Yes 5r 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 ---- 8 ---------- Material -----------------------------------____ bd No. of compartments -1— - �r_` ��r�_D Liquid depth_ 5Z.«___________Capatity_ Disposal Field: Distance from nearest weft---l0,0Distance from foundation_f110----------- Distance to nearest lot fine__ e..._____ Of Number of lines___l-----�7________________ Length of each line_----- n Width of trench ______------- .------------- Type of fi{ter material_Depth of filter mate rial___�-_.__ ___.___Total length ------ 3,0---------------------------- P Seepage Pit: Distance to nearest well-.._ ---_____=Distance from foundation_ -_____-_-,Distance to nearest lot line --571 ------ Number of pits_________ Lining material-_K/C.--___--Size: Diameter. -IJ -0 ........... Depth__ -_11_________________ Cesspool: Distance from nearest well_________________Distance from foundation -y-- ---------------- Lining material --- ------------------ .._._-----------_ ❑ .. , =._ _. _ Size: Diameter ---------------------------- - ---------- Depth_ -------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ---------------------------------------- _--- .---- Distance from nearest building .____._._________________-.___-__________. ❑ Distance to nearest lot line ------------------------------------------------ ---------------- •--------------------- --------------------------------- --------------------- Remodelingand/or repairing (d/ cribe)------------------------------------------------------------------------------------------ ---------------------------•-----------------------•-------- ------------•---------------------- 1 = r -- ----------------------------- l ------------------------------------ -------------------------------------------------- -- '------------------ I hereby certify that I have prepared this application an ° +hat the work will a done in accordance with San Joaquin County ordinances, State s, and rules an regula+ions of the /t�o Uuin Local Health District. a (Signed) r ` �`� A/----- r ---- (Owne � an dor Con ractor) By:---------------- - J�� (Title} r - (Plo+ plan, showing size of lot, location of system in relats, buildings, etc., can be'placed' n reverse side}. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ------------------------------------------------------------------------------------ DATE - -------------------------------------------- REVIEWEDBY -------------------------------------------------------------------------DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE. ---------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------------------•-----------------------------------------.----------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------......---- -----------•-------------------------------- -------------------------------------- ------------------------- 00 -------- - FINAL fNSPECTIQI-&Y:- = r��`r- ate---------- ------ ---�~ ` I ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California 5-4-7M ; Rpv;,Ar{ W-9100 300 West Oak Sfreat 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California