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q APPLICATION FOR SANITATION PERMIT Permit No....(O.J..L..V (Complete in Duplicate) J'A (" Date issued ....... ....... Applico+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 Ordinencc o. 549. JOB ADDRESS AN CA TjN ..... i5!Q.,.._....._.._. /.....�� ...................................-/-.._......._... Owner's Name.....-. 1...1sI..........._................... ......... »...... .... ...... _............................... Phone/St� 'S�1 Address- _..... v._.....__._...._.._.__._.•••__..._._......_.._......-�-L----..............-•---•---- Contractor's Name ................... O Q. .-�j ... ::tu-� .......... ................ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑//Motel ❑ Other ❑ Number of living units:.. Number of bedrooms -.. Number of baths . ... Lot size ...!t., X .........._......... Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table'ri.<l ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ No�( TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I AlSeptic T9d �d�/> _ Distance from nearest weiC� Distance from foundation... . ........ Material .�!C.. -................. ....__.... auak 1/No. of compartments.......1. .._ ..Size..0-1..1....................Liquid depth--- �. Capacity ........... ......... Disposal Field: Distance from nearest eII�hON:U..Distance from foundation. pzd... .------ Distance to nearest lot line...s...._. R( Number of lines................ .. ... Length of each line... ....... ,36..�......Width of trench.....2. .. .......... 1' Type of filter material --- -$t�.Depth of filter material _..... ../....... Total length ..... 2.4-1 ......................... Seepage Pit: Distance to nearest well.-,.. -, ...... . ..... Distance from foundation................... Distance to nearest lot line ....... _........ ❑ Number of pits . ...... .. _ ..... ... Lining material..._.._ _...... -.. Size: Diameter ................ .... Depth _...--- --..._._.. Cesspool: Distance from nearest well ................. Distance from foundation ............... Lining material ..... .................. _.._.._._. ❑ Size: Diameter.. ............. . ......... . ...... Depth .......... _............................... ... ..Liquid Capacity .......... __ ............. gals. Privy: Distance from nearest well.._-..-._ ............................... _....Distance from nearest building ... .... ___ ................ -_.. ❑ Distance to nearest lot line _ .......... ....... _................ ......................... ....... ...... ........................ ........ ..... Remodeling end/or repairing (describe):.. 'AA -191014p, ............. l�ee�.l�j•---- _a ..... A-oi&e,(x� _. ,.. .......... ..........__.._.. .._..___...._.............__.._._...._.�_._ .. _ ...-.-.._----_.-...._......._..«.._........_....._....._... -L. ..... ... _-__.... -......_...... __._............................... _. _ _.._...._.._ __.... ....... ............ ..... ........................................................................................._............... ......... ................................................. ...... ....................... .... I hereby certify that I have prepared this application and that the work will be done in accordam a with San Joaquin County ordinances, State laws, and rules and regulations ofthe SanJoaquinLocal Ktallth Disfrict. (Sig i ned !! """'*'.... L ``�!...::..IS O!E-` ...Sr'low and/or Contractor By; ............... ....... ............. �----........... ........_...._........-......._.._................................. (Title).... - - (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ _. ... ....... ............._...._ ..... b .._....._........._..... DATE ----- -....... r..3r.... . �....... ........ REVIEWED BY ............................... v ........................... .... DATE ..... BUILDINGPERMIT ISSUED ...................................... _................... _.....--.............-.......-..--....... DATE ... ..- _._......._ _..._......_......_._....... Alterations and/or recommendations: --.-__... --......... ............. ................. ._...... _... ........................... __..._..._..._.. ..._...._.._ _ ...---- FINAL INSPECTION BY:._....1... l = �.�3a...... ...... Date � ... I ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Proof 300 Waif Oak Strad 132 Sycamore Sfnat 014 North %— Street Stockton, California Lodi, California Manfeu, Cdifomla Traev, Cahrais ES -4-21A . Revised W-2100 A