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APPLICATION FOR SANITATION PERMIT Permit No. �- (Complete in Duplicate) Date Issued --�- -� Application 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. 4� .. JOB ADDRESS AND LOCATION--------Z-�-tJ---------Ir-€--- p't �t-�---- U --- ------------��-H.��--Crr2,' Owner's Name f"�,!/ p L l r-'ht G.-i'7�' Phone--------------------------------•--- Address--------------•--.1'4;7�9---------AlA----n4&-r------ -V e----------------------•-------------------- ----------•---•--------------------------------------------------------------.. Contractor's Name----------- C `�-rrc -------- 1I1rL --------------------------------------------- --------------------•-- Phone__ _ --------- Installation will serve: Residence ® Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_I____ Number of bedrooms .-2--: Number of baths -_•Z__ Lot size ___ 0_ Y®---------------------- Wafer _______________ _ __Wafer Supply: Public system ❑ Community system '❑ Private ® Depth to Wafter Table .- -- ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam X] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes P. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank—or�cesspool permitted"if pu6iic sewer is available"within 2001e0.)"-` _ Septic Tank: Distance from nearest well__-Distance from foundation____-_Jr-"_____.Materia!______CO A-4--t< No. of compartments------------•Z_--------- ------Liquid depth---------'�- _______Capacity... _-_�-_-____. Disposal Field: Distance from nearest well---- _____.Distance from foundation----;� �'�__-------Distance to'nearest lot lin'e Number of lines____._-___ Len th of each line' ❑ �- g f� � Width of trench-----------7------------------- O,Q Type of filter material---/e_Q4__1f----Depth of filter material------/_-----------Total length_________ _____________ Seepage Pit: Distance to nearest well_____ -_.___Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----_-----------------.Depth--------------- ---------------:- 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------------------------------------------- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------- ----------------------------------------------- Remodelingand/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)_.__----- 7---�Y�c�i-----1 rte.•------------------ --W ---�---------_ _-� (Owner and/or Contractor)� --------------- By:----- --------- --------- ---------,------------------------(Tilt lei ---------------------------------- (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 ? REVIEWEDBY-------------------------------- ------------------------------- DATE � ----------0---------------------- BUILDINGPERMIT ISSUED--------------------------------------------_"'`_�-_---------------------------------------------- DATE------------------ Alterationsand/or recommendations--------- -------------- ------ ---------------------------------------------------- ------------=-------------------------------------------------------------- --------------------------------------=-----------------------------------------------------------"-----------........ -•-------------- --------------- -----------------------------•---------------------------------- - rioe -- --------------------------- -------------------- -------------- -- "- ,--------- Y a F ____ -+ -µ-- ---•------- -- �------i-____ _._ ._ _ - _ _ ----_�."_�" FINAL INSPECTION BY:---- f - Qate 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 �rK . ES-9-2M 8-51 Revised W-2100.