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r �� „Permit No. _��"��'�--- _APPLICATION FOR SANITATION PERMIT ,6., (Complete in,Duplicate)_.H _ -Date.issued,:_//.7.1- 0_%S XTA�plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No_. 549- , ----------•------•----•---- ------ �"' _ ------------------------------- --------------- JOB ADDRESS AND LOCATION----------- -------- � - ff Owner's Name------ 'V ' "`; -J- -- ----- -- ------- ------------------------ ----------------- ------- ---------------------------- - --I----- Phone---- Y-3... Address.----- ---•------ --------------------------------------- A ----------------------•----------------- Confrac#or's Name `'!rti Phone----------------------------------- Contractor's ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installs+ion will serve:Number of living NuAbertaf bedrooms.. Coomber of baths __�____ Lot size.__ -D -- - ---•------ ----------------- g 1 _.N Water' Supply: Public system ommunity system ❑ Private ❑ Depth to Wafer Table I Character of soil to a depth of 3 feet: Sj�pNe Gravel ❑ Sal dy Loam [I lay Loam ElClay E3 Adobe [I Hardpan E]A Application Made: Yes E] No w Construction: Yes No ❑ Previous ppm, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic 7a Distance from nearest weli__.v""_'-�Distance fro four atio ion--- �--------. +�r�4ri ---""--"---" --"---------------- - " 1 No. of compartments. Size '� Li uid de th----IA- ------------Capacity_-;�v--- ---� _ Distance to nearest lot line__ ____.__.____.,� Disposal Id: Distance from nearest well._-(._.Distance from foundatian_____1._.______ . Number of lines----------�- �_ -;��Depth - Length of each line:----- �------tR----Width of trench------.---.--Z�----------- ------Total len th------------ I � ------------ Type of filter materialof filter mater-la4____.____i��. g - ;- Seepage Pit-. Distance to nearest well_."___________________Distance from foondation_____ ------------rDistance to nearest lot line_________________ Number of pits_. Lining material--- - -.Size: Diameter------------------ ----Depth- ---------I Distance from nearest well____________ __Distance..from' foundation------ --Liquid _ _ ____.___.-- Lining material____.__.-_.__._______--.._.____.._._ _Li uid Capacity_ gals. ❑ Size: Diameter-------------------------- ----------Depth-- ;:�: ----•------ ---_"--------- q p Y V.I. Priv Distance from nearest well"------___.______ ___________�---�° .-Distance-froom nearest buildings --------------------- y:' ❑ --------------------------------- --- Distance to nearest lot line--------------------------------------------------I----- Y} Remodeling and/or repairing (describe)------------------------------------------"-------- ----- ------------------------••----------•--•-----------------=--- ---------•------------------------------------------ I 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, and rules and regulations of the San Jo uin Local Health District. v caner an r Contract Signed --------------------------------------- --- -(O d/o or( G I Title B :•---------- ---------------------- (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-------------� s- �`;S ------------------------ ---- - ------ DATE---------•-•------------••-----••------------------•-------- REVIEWEDBY------------------------------------------------ ----------------- •-------- -------- � ------------- BUILDINGPERMIT ISSUED---------------•---"-------- ------------------------ DATE------------------------------------------------------------- q e Alterations and/or recommendations:---------- ------------------- -----•-----•--------------•----•- �-- -------•--------------- - -------- ----:.-"---- ------------------ �- - ---�= - -----�----- -------- ---------- k - --- ---------------------------- ---------------------------------------------------------------- ---j------- _- --------- ------- ----------------- FINAL INSPECTION BY:...- --------------------------- } Date --- --� SAN JOAQUIN LOCAL HEALTH DISTRICT J 814 North "C' Street 130 South American Street 300 West Oak Street y� 1132 Sycamore Street Stockton, California Lodi, California �`€•Manteca;CalifornTracy,�California ES-9-2M 10-52 Revised W-2100 N.