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A V 3PLICATION FOR SANITATION PERMIT Permit No. _--____ (Complete in Duplicate) Date Issued o`!�✓_ N. A pplication 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. ;t-&(eL.0vv . , u 61 'r3e.- a JOB ADDRESS AND LOCATION-----r 1 .1- --S--- 52.2s --- 'b¢ '--- -: -ba,LI a X'-- 'u ---f Q___ .;� ---=-*--- '�1 --------- Owner:5 Name ' `t.m 'ri �: i0 i.1?X'i C; = 8 8�`11 �' V,:OT1 �.C3�r P�io11OS' 2 Il1 i _ -------------------------------- --------------------------------------------- ------------------------------------ Address------11 ---7's--•m:Q ---Ur-n- --------------------------------------------------=--------------------------------------------------------------------- Contrac:tor's Name------Da" ta -------- ---------------- -------------- - -------------------------- Phone-- E] El ❑ L__1_ ---~-�:--- ��BO 3� ` Installation will serve: Residence Apartment House Commercial Trailer Court ❑ Motel Other t. Number of living units: _____1 Number of bedrooms _ �_ Number of baths __ Lot size __2i;�r7-DC��__ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ---- Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sand Loam Clay Loam " Clay '- Y ❑ y �] y ❑ Adobe❑ Hardpan ❑ �` Previous Application Made: Yes ❑ No [2 New Construction: Yes [2 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we11---------3a,0__Distance from foundation----4'___--___.__.Material____ © 0'__'_x-_4'_x._4 r ........ 5'-a3 1 No. of compartments---- �---------- --Size---�r--t'�-- �1-- ---------Liquid depth---- -- ----------Capacity---L=C Disposal Field: Distance from nearest well----UO--------Distance from foundation____1Q-_____-_.Distance to nearest lot line------------ ❑ Number of lines,----)W--------------------Length of each line-------1M----._____--Width of french..... _-------___- ---------- Type of filter material-AM----------Depth of filter material----._--_____Total length---------�----_-_ _--_ Seepage Pit: Distance tonearest well-- -----Distance f . m fo fidation___-,/______._.Distance to nearest lot line----------------- p 71 . Number of ifs---------- Linin material_ g - ��-�---Size: Diameter_---��---�---------Depth_-�/Q_�----------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material _________. ❑ Size: Diameter Depth- .::----- -------- -------Liquid,Cap acit ------------- gals. Privy: Distance from nearest well_______________---------------------------------Distance from nearest building - ----------------- Distance to nearest lof line------------------------------------------------ Remode'�ing and/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'fhe San,'oaquin Local Health District. (Signed) w.-----•----------------------------------- x (owner and/or Contract (Title)- - --------------------- P of 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__ y ------------------------- t DATE-- REVIEWED BY - -------------------------------- u � BUILDING PERMIT ISSUED-------- •-------------- DAT ------------- E ------------- ----- -------- DATE----------------------_--- ------------------------------------------------------- Alterations and/or recommendations---------------------- € ___________________ _______ _4____,.________-_--._______ � F ----------------�------------- ------------- ---------- -------------40------ 9 .1_ _---------- --------------------------------------- " __1__ _�__ ' ___ ________ _________________,_______ FINAL INSPECTION 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 9-51 Revised W-2100