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� �_ `z APPLICATION FOR SANITATION PERMIT Permit No. _ ;__ __=______ (Complete in Duplicate) Y�A_ S' S k Date Issued - ----• ------ f p_i;o �'.:-.L:c ff lTLs�c�aaJ._ - Application is hereby made to the San Joaquin Local Health District for a permit to construct and, in t t e woW--herein described. This application is made in compliant rWi+h County 9,xclinance No, 549. it C� JOB ADDRESS ND LOCATION la------- ------ -- ------------- --------- ---------------------- -- --- - �-ate ------•-- Owner's Na ® $ 4�.. -•- 1 ------ -- �-------- nem / Pho Address--------- - -------- -----�'.-•-G?-.- -----------U------------------1 --- -- ---------- -- --- ----------------- ------------ -------- - ----------------------------•- Contractor's Name---- -•-- - -----•r ------ ----------ZLrJ.Q f---------- - II—p-.4- ----------' ------------------------ Phone------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel P Other ❑ Number of living units: .--/--- Number of bedrooms __/fit_ Number baths _ --- Lot size ____1_s __ __ _S _Q_�_-----_-__--� Water.Supply: Public system El Community system C1Private epth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E].- Clay Loam Clay ❑ Adobe❑ Hardpan, Previous Application Made: Yes ❑ No New Construction: Yes R"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) r 1/7 nk: Distance from nearest well__-- istan e fro fou tion--- __.____.Mater' I - --- --- -- - - - ---------- Septic,; p No. of compartments-----------�----- _Ssze_ __ _ - -_ _-_--Liquid depth--------q ----------Capacity--_._- - -- Dispos Field: Distance from nearest w 1_ _ _ istance from foundation- __ Distance to nearest lot Eine __F __ _ F -------- Number of lines-------- _____ _Length of each line_________ �__ Width of trench__ _____ _ _ 4 - - f t. Type of filter materi __________________ "epth of filter material_______l �r_-_-__Total length______1_ _ ___________________-___ r Seepage Pit: Distance to nearest well___________________Distance from foundation____________________Distance to nearest lot line_:_____.______---- _t, I] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------------------_-----_- Cesspool: Distance from nearest well________________Distance from foundation__________________ Lining material________________-__-___---___•_---__ ,-, ❑ Size: Diameter b ��. F ------- _Depth_= :_. �---r -:__: quid`Capacity- --•---•---------------•---gaIt., Privy:- Distance from nearest well___________________________'___._-_____-__-_-Distance from nearest buildin ❑ Distance to nearest lot line---------------- - ----------------------------------------------------------------- ---------g------------------------ --------=•---- 1 Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------•---•--------------------------------•------------------- ' `F'� - - .._ - . - .... --i- �W — - ` -----------------------------•--------------------------------------------------------•---•-------------------------------•--••----------------------•--------------------•-•---------••-------------------------------- hereby certify +hat I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules andV10C ulatio of the San Joaquin Local Health District. (Signed)------- --- ----------- -----------------------------------------------------------------------------(Owner and/or Contractor) IBY----------------------------------------------------------------------------------------------------------------- ----------------(Title)--------------------------------------------------------------- (Plot pla , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B �{----- ----------------------- ------------------------------------------------------------ DATE__7� = REVIEWEDBY----------------------------- = - DATE------'�%,N---------------------------------------------- i. BUILDING PERMIT ISSUED------------- -------------------------- -------- ----------------------------------- DATE__.. -- --------------'---T---------•- Al+erat's ns ant!/or recommend atios: _-'! -` ---- - - ------- - ------- -"-"'�!--?�=�___"?T ------- ----------------- ----------------- �°^� � � � _,�,�,,, 4' , / , `.�.• .'"'� /------`--- _ �.�---�.._------------- -� C5 ---- -- -- -- - ------------------------ --- ---------------------- - I ------------------------------------- -------------------------------------------------- -------------•-------------------------------------------- FINALINSPECTION BY-------------- ------------------------------------------- ----- Date--------- -------------------------------------------------------------------- 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 ES-9-2M 8-51 Revised W-2100 '_ . -�j