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#"oar= *. APPLICATION. FOR, SANITATION PERMIT Permit No. 1 (Comp lefe in Duplicafe) D ate 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. fff �_ .iJ_.s , . JOS ADDRESS AND LOCATION._��_ ___fa '_ a _`_____; .____ -------- ._ . " Owners Name = -------"�- = ----- ---- --- - - Phone. -- - --- --- - -- e� Lia 5 1� - _ -. - Address__ , , _ " ' ! ----- Contractor's Name Phone f---•------ ------------------- Installation will serve: Residence Z Apartment Hos [❑ " Commercial ❑ Trailer Court ❑ Motel ❑-'CIther ❑ Number of living units: J--: Number of bedrooms P-2— .Numberof�baths _:Lat si e'_-__-------___ ___'--' "'- ------------------------ Wafer Supply: Public system ❑ Community system ❑ Privafe.Kj Depth to Water Table Z ft.- Characterofsoil to a depth of 3 f ef: Send ❑ Gravel ❑ "Sandy Loam ❑ CIay;Loam ❑` Clay ❑ Adobe,® Hardpan ❑ �... Previous Application Made: Yes ❑?No E' New Construction: Yes NJ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic fahk or cesspool permitted if public sewer is availabE e�wifhin 200 feet.) l ��Sep 'c Tank: Distance from nearest welt-----_-I-------_-D.istance-from foundation_--------_°__ _.+.'Material______________'.__. No. o� compartments i- Size ::_ Liquid., --_--•-----------Capacity----------------- --- Disposal Field: Distance from nearest well---G 0-.`.-.-Distance from foundation---- __--.Distance to nearest lot PKNumber of lines----- -------------------Length of each line_ -------Width of trench- -w+,. -------------------- Type of filter material__Sc_ 4&--__Depth of filter material----.I_ .`� �4__ :---._Total length"---------a� Dumber of its._-.._ from foundation...................Distance to nearest lof line._-__.___--.-_-_- SeepagePit: Distance to nearest well-.___ d Distance f -, p -/---------__Linin`g�material_ _ .Size:"Dia.meter----- -a_---.Depth------R a- ----------------- 3 `� e - F Cesspool: Distance from nearest well-------- ._ _Distance from foundation--- ._;L'ining ateriaL_____._________________________ ❑ Size: Diameter Depth �D - 4' Liquid CapitY - gals.. Priv Distance from nearest well____..___r_--------------------_______-____.___ istance from nearest building--' ❑ + .. - Distance to nearest lot line- ---------- ------------ ---- -- ------ t- .. i ��}} - Remodeling and/or repairing (describe)----- U� ' --- _-__-_--'- -1-11 -'-- ---- - - ) --------------------- t - --•---'?�- ------------------ ------------------------------------------------------------- ---------------- -------------- - --------------------------------------------------------------------------------------------------------------- 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 fhe{San'Joaquin Local Health District. r . _ ---------- (Signed)- weer and/or Contractor ------------ -- - -- - ----- :------- _ -----[' / ) •--• �---------------------------------- ----- - T�fle. By------------ - -s.�?..�?-..-• - --- -- - -- --,--- � - --[ 1----- --" ---------------- ------------------ --------------- (Plat plan, showing size of lot, locafion of sy em in relation to wells, buildings, etc., can be placed on reverse side). IE FOR DEPARTMENT USE ONLY, ` APPLICATION ACCEPTED BY--------- - --- -- -- �L ''Lr =--------------------------------- DATE-J, --�3 11�-�-•-----------•------------------- REVIEWED BY------------------------------------ -------- ----- --- ------------- --------------------------------- DATE'._-.,e__ k BUILDING-PERMIT ISSUED--------------------------------------- - - DATE T 5 Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------'^ } --------------------------•----------- --•----------•--------- ---------- ---- -- ------- -------------------------------------•------------ , ----------------------------------------------------- ---------- F I -----------------------------------------------------------•---..__--.--__-_---_-_.-------._-.------_.---_--.-__----------_-----__--------_--------------_----------'---------_---____--__--..------_------_--_--_-_-.., -_-, ___ __ _ _____ __ _ __ __ _ ___ _ __ _ FINAL INSPECTION- BY:------- z = ------ Date--..----.--------------- --n----------- --------------I——-------T SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 Soefh American Street 300 West Oak Street 132 Sycamore Street 9'14North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M ' Revised W-2100