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APPLICATION FOR SANITATION PERMIT Permit No. _ Com lete in Duplicate) 9-7 z { P P } Date IssuedE7--__--�_6,-�,,C Applica{ion is hereby made to the San Joaquin Local Health District for a permit to constructt i[ st I the l ork hereindescribed. This application is made in compliance with County Ordinan No. 549.' ., JOB ADDRESS AND LOCATION _ 4 i?arn_.. CJ, --- -�' ---��- � ---- Ed------------ Owner's Name---------F ed---------UEZ1�1'a_txx 'c` '��'�`1...-- edd '-Y Phone' ? Address------------------------k'�'--3�-!'?lstl� ��ip -- - -----------------------------------.--------------------------- --------------- ------•--- Contractor's Name------------------------------ ------jc17p!�-`--------------------------------{------- Phon ? Installation will serve: Residence;Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_I__._ Number of bedrooms .J___ Number of baths! �Lot size __I,-/ _.__ _.. �_:___________________ Water Supply: Public system'❑ 'Community system E] Private�Depth to Water Table _�fL t:�►— Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam ❑ /Clay ❑ Adobe V-Hardpan ❑ Previous Application Made: Yes ❑ Nox, New Construction: Yes,No E]TYPE OF INSTALLATION AND SPECIFICATIONS- (No s (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic/�Tank: Distance from nearest weelll__ Distance from foundation/_ ______________M ial_______-___ ____.__________. No. of compartments----�______________._ ?-�3C �____�S_Liquid depth___- ------_-Capacity/4 r/ ,v �Ir _Size__ _ ��7xxr!!!!!``"` Dis s Field: Distance from nearer we![_ Q:_._. Distance trom foundati n__ r---Distance to neares otlne_� __ _ N Number of"lines____________ _y_�............Length of each line__ 0_-A��________-Width of trend____ ____��_________________ Type of filter material---I_V--------------Depth of filter materiaLj?--------- _Total length__----------._....__-_-_._-.________- 9 __ Seepa- e Pit: Distance to nearest well---�Q�} ____Distant f foundation____ ____________.D stance to nearest lot line........ I ��$$,f� Number of pits----1---------------Lining material�i'�1 -.Size: Efriameter._. dr___Depth ---------------- d 1 Cesspool: Distance from nearest well-----------------Distance from foundation_.--,--------------Lining material-------------------------------------- El Size: Diameter----- ------------------------------Depth--------------------- --------------------:--------Liquid Capacity----.------------- ---------gals. tDistance from nearest building Privy: Distance from nearest.well --------------------------------------------- 9------------- ---------------------------- S ❑ -Distance-to nearest lot line----------------- ---------=--- --------------- ------------------------I-----------—--------------------------------------------- ------------- Remodeling and/or repairing (describe)----------------------------------------------------- .---•-------- _----•-----------------------------------------------------------------y--•------- ------ --------------- -------------------------- ---------------------- ------ ----------------------------------------------------------------------------------------------------------------------------------:---------- ---------•-------------------------------- 1 hereby c rtify that I h e prepared.this application and that the work will.b . done in accordance with Sen-Joaquin County ordinances, S to I s, and r les and gulations of the Joaquin Loc I H alth istrict. e (Signed) 0rt,)--- - -- ------------------ ---- ontractor By:---------- ----_---------- ---------•----•---------------------------------- -- ------- - (Title} (Plot plan, showing size of lot; location of system in relat to wells, buildings, etc ca be pIced on reverse side). FOR DEPARTMENT USE ONL i APPLICATION ACCEPTED BY------------ ----------- ------------ ------ DATE-------------- ' - - fREVIEWED BY----------------- '=--------------- ----------------------- ------------------- -------------------•----------------------- DATE-----------------=--- ----------------------------------- 8lJILDING PERMIT ISSUED_ - A �' -------------------------------------- Alterations and/or recommendations: �'_-.z-----------------------------------------------------------------------------------------=--••---------=--•---•-----------•------ ------------------------------------ -------------------------------•-----=-- -------•-- -------------------------------------- ---------------------•------------------- -------•---•---------•-.----•--------------------------- ----------L------------------------------` ------------.------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- --------------------------------------------------------------- - -----------------------•--------------------------•------------------------------------------------- --------- --- Date.-------- `--- - ----- FINAL INSPECTION BY:------ �~ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street t 814 North "C" Street Stockton, California Lodi, California Manteca,California.'_ Tracy, California ES-9-2M , , Revised W-2100