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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) r � Date Issued __-. _---------------- A 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;infcompliance with County Ordinance No. 549. o - JOB ADDRESS AND OCATlON---I-- �--�-- �- �--��-�- -a_h�� --------- -••------------------------------------------------- ---------------------• ------ Owner's Name}-------C o h��l u= 1I----- _ A_A---------- -- ---... Phone--� --�--------��-5---- Address ! 74 h L E' Ccs f G'p 964 --------- Contractor's Name--------•-•-------- ------ W-j? `e_f"_---------------------------------------------- ---._. Phone----- f- � Installation will serve: Residence ❑ Apartment House ❑ Commercial X Trailer Court •¢Sll�aoMo7'tel ❑ Other ❑ r r •}-at�er''s vaHO �: Number of living units: -------- Number of bedrooms ________ Number of baths -------- Lot size _________________________-9------x__Ifo-----.--- Water Supply: Public system ❑ Community system ❑ Private [4 Depth to Water Table __—:_ ft. Character of soil to a.depth of 3 feet: Sand E] Gravel E] Sandy Loam 4Clay Loam [] Clay E] Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No X Now Construction: Yes IN No ❑ JJ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) �4 „ r Material___5Zo u-a�C .r,k,�--- Septic Tank: � Distance from nearest well--��d_____Distance from foundation__.�_�-___.__ _. No. of compartments------2--------------Size__________'-__)6__. =--•Liquid depth-----4--_--------------Capacity__lQ__ Disposal Field: Distance from nearest �-CSU-.._Distance from foundation___�X____-Distance to nearest lot Gne_ ____ w IL __________ _ -__ _ s Number of lines_ ' P -.___-_Length of each line___' _ -------Width of trench----___- T /� �- --_----Total length----- Seepage Type of filter material-��_..�._ _ a _Depth of filter matenal___.�____._---_ , Seepage Pit: Distance to nearest well------ ---------------Distance from foundation--------------------Distance to nearest lot line----------------- ;1__r ❑ Number of pits----------------------Lining material------------------------Size: Diameter------------------------Depth-------------------_------------- Cesspool: Distance from nearest well _______________Distance from foundation--------------------Lining material----------------------------_-__-_ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- - Li uid Ca acitY-------�------- ----__ a_s s• i , Privy: Distance from nearest well----------------------------------------------t_Distance from nearest building------------------------------------------ 0 ❑ Distance to nearest � lotIine--------------=r----------------------------•--------------------------------------- -�----------�--'------ e �-e--r-�-,-------�--�- - Remodeling and/or repairing (desc used � � —c -------- ---• ---------- --- ---- _a-A . -------5�110W ---------------Con _ala-'------------------------------------------------------------------------------------------------------------------------------•-------------------- ---------------------------------------------------------------------------------------------------------------------•------- ! hereby certify thaf-1 have prepared this application and that the work will be-done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. [Signed) '„!I`_ -. ------------------ -- -------------------------- -- ------------- ------(Owner and/or Contractor) Title By------------------------------------------------ (Title) (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 --- -_ ___._ _-_-_�___ _1- - -------------- DATE ► REVIEWED BY - ------ DATE------------------ REVIEWED PERMIT ISSUED------------- / ------------------------------------ --------------- -------- DATE.--------' r c Alteratio s and/or recommendations:--. !____ 'S- -- -------- --- -- • - - ------------ -F _ ---- C.----- -� - -- ------- ----- ... -------------------------- ------------- - ----------'-�------ --- I------•----- *----------------- - DatFINAL INSPECTION �------------ E 4---- ------------ ----------------------------- ---- ANIJOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore S+tee+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M : Revised W-2100