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. y Zishereby, APPLICATION FOR SANITATION PERMIT Permit No�_'��"�__________(Complete in Duplicate) q/Date Issued -/--�`S�Appliade 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. }- �Q JOB ADDRESS AND LOCATION--- �1' •41 ��1�t-G+�--[-�/--.G�-�" --�-,rf .�G�.�ll,2_Q.gl.�.•S Owner's Name-41110-4a-111,-7-0-1-----f -.%1✓/ 7rC�___ Lit Phone_- -_--- -------- Address - - ff f� '� � i Contractor's Name-",a- /rt'['f i_�i_ s��PV� __x1?__C<------------------------------------------------------- Phone__9:-- -7-------. Installation will serve: Residence 1�9-<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-f_-_- Number of bedrooms --Z_ Number of baths __ ___ Lot size __T _-__ ___/_tea---___________________ Water Supply: Public system Ft sCommunity system -❑ Private ❑ Depth to Water Table --'f---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes © ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well A/4%Distance from foundation_--,/0---_-------Materialvw—n--- __;'--__------- No. of compartments---- -- -----------Size G. -`' -- .�_`�_Liquid depth-----�1'..----._----Capacity---�4�_6�-- Disposal Field: Distance from nearest well_/ '' -- r �1 Distance from foundation___�_�__---_Distance to nearest lot line.-� ______---- Number of lines---------:2-----------------------Length of each line----4 ----_---__-------Width of french-'a--f. ... Type of filter materialf 2_a_l>?ai�' Depth of filter material-_-_ --------Total length------L�CP_--__________________ Seepage Pit: Distance to nearest well_____________________Distance from foundation- ------------- to nearest lot line_____-___________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------ Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material-------------------------------------- 0 Size: Diameter--------------------------------------Depth------------------------------------------- ------_Liquid Capacity----------------------------gals. , Privy: Distance from nearest well----------------------------------___________Distance from nearest building----------------------------------------- El Distance to nearest lot lin_l /9e 2 Q 1 Remodeling and/or repairing (describe):______ -___t1___-i,__f eA41_____________________ ..........--------------------------------------------------------•....-------------------------------------------------•------------------------------------------------------•------------------------ i --------------------------------------------------•............... ------------------------------------------•--------------------------------------------------•----------------•-------------------- --------------- 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, a. rules and regulations of the San-Joaquin Local Health District. � (Signed r ---- 4,,1�� -� -� P1 j. ��-----' - --- ----------------------------------- _______(Owner and.or Contractor) ( )--- .^- --------------=----------------------------------------- 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 BY--- --------------------------------------------------------------------------------------- DATE- � REVIEWED BY DATE------ ` BUILDING PERMIT ISSUED ---------------- ----------------- DATE-------- Alterationsand/or recommendations------------ -----------------------------------------------------------------------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 t LS-9-2M 8-51 Revised W-2100