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�U4 j + 1� , 4 v 11 APPLICATION FOR SANITATION PERMIT Permit No. � -----. 1 i/ (Complete in Duplicate) / r� Date Issues/!r/6-__________ 1 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. JOB ADDRESS AND LOCATION------ - - -- ----- o,�-- - I ------------- --- Owner's Name---------------- __0------• A_ S Q.h_ ._c]_1 �Q17 5- G `$►'�---�� ------ Phone-- --r-�Q .. Address---------------------- '..... ------------• ---------------------------------------• /-- -------------*...... Contractor's Name------------- =�---- ��ekj;S-----------�`-��--f•---------------------- ---------------- PhoneT_JO- b•;7 4 D ---- Installation will serve: Residence Apartment House J] Commercial ❑ Trailer C�qurrf❑ Motel ❑ Other D_!f� _ umber of bedrooms -------- Number of baths --_/ - -_ Lot size ______- s;r' t �_ �- -- -- -- ------------- Number of living unitsll Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 3A ft. i + Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ ClayLoam ❑ Clay E] Adobe E]Hardpan Previous Application Made: Yes E] No New Construction: Yes El No ER 1CIs w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ p r Septic Tank: Distance from nearest well-11404€_-_Distance from foundation_,/d---------.Material _______ No. of compartments___--'�______________Size__� �� __ _`�_ Li uid de th.__ `/ G � ,�-- q p. s��--- --------Capacity__5i_p-o-------- jb l Number of nearest well.94P.— +_Distanceirom foundation__/_4_'�-----Distance to nearest lot line__O-_ Disposal Field; Distance from lines___.__=__�___f_ _ � Length of each line____�_. _____�,'__._.Width of trench '_ , See a e Pit: Distance material__! -- -------Depth of filter material___._:___ ______Total length------ Seepage ___-_ Type . p g ! o nearest wellr"-'� pistance fr fo ndation_j_Q.-_-__.Distance to nearest lot line--------4___� Number Of pits--- ------------- --Lining material---- ------:--- ---Size: Diameter_ `�-----Depth_____2-�__-� Cesspool: Distance from nearest well_________________Distance from foundation----------------_---Lining material ____.._.___________._ ❑ Size: Diarrieter-------------------------- -----------Depth----------------------------------------------------Liquid Capacity-------- ------------------gals. it Privy: Distance from nearest well-------'----------------------------------------Distance from nearest building------------•---------_----- ❑ Distance to nearest lot line ---------------- _ II aa / �/J� Remodeling and/or repairing S--"j&-cl/27.__�L_, '! _,�. -----------------------------------------=------------------------------------------------ ----` --- --------------------------------------------------ii----• -------•------------••--------------- -- �r ---------------------------------...-------•------------- •--=-----------------------•----------------------------------------------•------------------- I I hereby cermy-thaf ve prepared this application and that the work will be done in accordance with San Joaquin County " ordinances, State laws,, and rul s and egu*1 f ons,of the San Joaquin Local Health District. (Signed)_.. NIJ-- --- ----- _.�. .. t ---------- --- - -------- g :, ) ----- � 'Contractor) Y=---------•------------------------=---------------------------------------------- ------ --- ------- ------ --------------- D ---------•-- - (Plot plan, showing size of lot, Iocation of system in relati to wells, buildin s, etc., can be placed on reverse side). u Ji FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- --- _____________ ` �_- -----------------------_-___--_------. DATE-----�_,.�._ ---- ------------------------------------- REVlEWED BY__. = -------------- " ---- - DATE -- ------------ - - - - - ----- - -------- --- BUILDING PERMIT ISSUED -' --------------------•--------------------------------- DATE__--------------- Alterations ATE.- _-------------- Alterations and/or recommend ations_------------------_____-_---------------- `_ -------------------------------------------- -•-------------------------------•-------------------------------------------------- ------------------------- -------•---------•--•----�---•-•--------•------ •. ---•------ --•-------------------------•-------••-- .-------•---------------------------------------•--------------•----------••---•-------- -------------•-•----------•-----------•-------------------------------•--- �I ---•------•--------------------------------- - ------------------------------------------------------- ------------••-----•----------------------------=------------ -------------------------------- ----------------- ---------- 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 : Revised W-2100 N