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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �/ - _ Date Issued ----s 117_ V 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. � — .��•� J08 ADDRESS AND • r�'-�/LOCA IOND�'-- � � 1'� _ elk-Ft ! 99y � E' fl` i OAF---- OLIE>'Ao!% Owner's Name------ ---------•-/-------- 1 _�_�_ -------------------------------------------- ------------ Phone-- .3a_�L- ------------------------ Address-• • --'------=� --------f-�---0 Q C I S - Contractor's Norrie -�' A.1.1-1� --------------- ---------- --- ----.- Phone - 'c Installation will serve: iResidence ❑ Apartment House (] Commercial [I Trailer Court E] Motel &I Other 4,, ❑ Number of living units: __ Number of bedrooms __-__=_ Number of baths ___ .._ Lot size ------------- - s Water Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table -------- ft. =,�. 7' Fed Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ �Har'dpa i�� Previous Application Made: Yes ❑e NoNew Construction: Yes W No Q TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet:) Septic Tank: Distance from nearest well_7O---FT_DistanLS-from-oundafion_A3_lT,___Material__.oPd QRE-�_•_--!�.C2_yv��g�C No-of compartments--------_ `----------Size__7r,"2( X__ _--Liquid depth------ j .-{---- --:Capacity------- Disposal ------/G Z{�- K `� �O f / D'rs osal Field: Distance from nearest well--_.�-�_.__.--_____Distance from foundation------/a--__.__.Distance to nearest lot line__.___-S____. v p . Number of linos_ _-- __ -------Length of each line---_--l0 _`_-------------Width of trench-__---- _'Zc v Type of filter material.�_r�!-_Depth of filter material___---__/i..'........Total length--------- Seepage Pit: *Number to nearest we!)- ------------------Distance from foundation-------------------- me to nearest lot line----------- _ �f Number of pits--------- p ___Lining material_________________.___Size: Diameter'____ Da tri__":.____ _�D'. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--- -------------- -• _Size: Diameter = - - Depth ----------- JLiquid-C ❑. - _.. ,� . .: _ — opacity-- Privy. Distance from nearest well------------ -------- -------------- Distance from nearest building " ❑� Distance to nearest lot line------------- ---- --------------------------------------------------------------------------------------------------------------------------- Remodeling ---- ----------------------------•-------..-•-- Remodeling and/or repairing (describe)-------------------------------------------- 4 ------------------------------- ---------•---------•--•-------•--•----- --- --------------------------------- ---------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health.District. ; i (Signed) 5/_ -^• �! ,."= '` � - " ` '- 3 -•--------- and/or(Owner an r Contractor) By;--------•------------------------------------f---------•------------------_----------------------•-----------------------------{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 8Y - --- ---------- -------------------------------- --------- DATE_------------ ----------- REVIEWED BY ----- -- DATE-_ BUILDINGPERMIT ISSUED. ----------------------•------------• ---------- DATE - -------------- Alterations and/or recommendations----__-_-_..___.____.. ' - ----------------- ------------------ ------ 011 `"4 Lr ------"J' ��= Gam.-- �> .. - -------------------- 1 ------------------- -••- ------------ ---------------------- ---------------------- --•----------------•----------------- ------------------------------- ----------- FINAL INSPECTION ----------= ---- 1 a � - c, 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 t + ES-9-2M ; Revised W-2100