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_ APPLICATION FOR SANITATION PERMIT PerNf.. _--2-- ` (Complete in Duplicate) _ 5yZ Date IssuedY - Application is hereby made to the San Joaquin Local He Ith District for a permit to construct and install the work herein described. This application is made in compliance with County Ordi ante No. 549. ' JOB ADDRESS AND LOCATION...... __ _4/41214__t4;C'. I_ Owner's Name 1.9': --C------------- ------------ Phone "� L Address ------------------------------�r_Z---42--- 7__ ------------ ----------------------------------- Contractor's Name------------------- I j e------- --O--A-�'�`'�f_241 ."'4-- -------------------------- Phone--- Installation will serve: Residence X Apartment House ❑ Commercial ❑ , Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: __.-__ Number of bedrooms _ __ Number of baths __l__ Lot size ___s ' ----------•---------------------- Water Supply: Public system 9 Community system ❑ Private [] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑( Previous Application Made: Yes p No 14 New Construction: Yes No ❑ V� TYPE OF INSTALLATION AND SPECIFICATIONS: I` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well_K0nZ---Distance from foundationIQ...........Mat Material---- No. of compartments-_____-_ ___ _-----_ Liquid deth- rr __ aac. ------ -------?-_----.- Disposal field: Distance from nearest well-10-OnZ----Distance from foundation_ -_�'---_Distance to nearest lot line Number of lines---A__-__ g �- ----- ! �+ - ------- Length of each Line....•-__--______,T� .W�dth of french--- 4 Type of filter material----�_J, _____ ,_Depth of filter material_-1 _--"---_- Total length----- ----------------------------- ---------- ________________________•. Seepage Pit: Distance to nearest well----------------------Distance from foundation_-__-_--_.__.._---_.Distance to nearest lot line---_------------ F1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------__-__.__-_-- -___:_ El Size: Diameter ------Depth----------------------------------------------------Liquid Capacity-----..------------ gals. .. - Privy: `Distance from nearest well____________________________--_-___----___----._Distance from nearest building------------------------------------------ Distance ---____.--_----_-_--___---____._.-_- ❑ Distance to nearest lot {ine_________________________._____-------------.--•-----__ Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------------------------------------------------••----------------------------•---------------•------------------- •-•-----------------------•------------- --•-----------------------------------------------------------------------------. -------------•-- - f •-------------------------------------------------------------------------------------------•--•---------------- ------------•-----------------------------------------------••---•--------------•------------------ r{ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F ordinances, State laws, and les and regulations of the San Joaq�Locallilth District. (Signed)------- ( [�-- `f'----- �'Y� ----- ----- ......................................... ----------------- -- --------------- ------ Owner and/ on By:--- !. `-' -- ----- ------------------------------------------------------(Title) - -- -- ---------------------- (Plot plan, showi 9 size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________________ DATE________________ REVIEWED BY, 4 T ------ - ""r"�----------- DATE-------------------- BUILDING PERMIT ISSUED rDATE A terations and/or recommendations------------------------ ------------------------------ --------------------- ------------------------------------------------------------------------------------------------------------- ---------------------------- ------------------------ ----- - ---------------------------------------------------------------------------------- FINAL INSPECTION BY------ - --------V �� -~' s°'� - ----------- 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 8-51 Revised W-2100