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APPLICATION FOR SANITATION PERMIT Permit No. .J �l____.____ t [Complete in Duplicate] Date ,lam , ,_, ._ ; -. -� . Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicationris.made:_in.compliance with County Ordinance No. 549. 16 r JOB ADDRESS AND LF OCATION_ ul/t-k)��` - GO 7 -P = !,Fj' _ -4 1_ 4 2 r 1,4 1X2,11 ------------------------ ------- -----------•------------------------Owner's Name ��/ me ------i Address-------�ll ------ 6� . Cl .._._ 6 Contractor's Name------ -------------Fcel:-f''1►s- 7 Phone r Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other pr-a-�'+i?s/:c Number of living units: 14-_ Number of bedrooms/I___ Number of baths _117" Lot size ._`_ _f __`-_)S_ __�_______________________ r - Water-Supply: Public system 2'Community system ❑ Private ❑ Depth to Water Table _ -1_ ft:-f-1 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 ❑ No ❑ TYPE OF INSTALLATION AND SPLCIFICATIONS: i - [No septic tank or cesspool permitted if public sewer is available within'200 feet.] ~ S is TV K Distance from nearest well_________________Distance from foundation--------------------Material---------------------------------___.._____-__- �}' .wty No. of compartments---------------------------'Size--------------------------------Liquiddepth--------------------------Capacity----------------------- DW --------------- --------Capacity----------------------- Di osal Field: Distance from nearest weft____------- __Distance from foundation--------------------Distance to nearest lot line---------------- iA 'e Number of lines----------------------------------'Length of each line-------------------------_•._.Width of french---------------------------------- Type of filter material________________________ Depth of filter material-------------------------Total length_'"__________------____________:_____-- Seepage.Pit: Distance to nearest wel!_A66-- --_-Distance fr m foundation__Ik___________.Distance to nearest lot line------`s__°4___� Number of pits-1-1______________Lining material_0AA_____,Size: Diameter__-�"._..__.____Depth--- �`______________-__.. . Cesspool: . Distance from nearest well-----------------Distance from foundation--------------------Lining material__._________________________________ ❑,� '-b- Size:eQiarneter�=: r = ' Depth-=-=--`---°:.---1-==--- - -__-- �-'Liquid Capacity""' __;�'_ gals Privy:} Distance from nearest well.____________________________ ----- ------- --- _Distance from nearest building-------------------.--------------------- ❑ Distance-to nearest lot-lire---__---_-__ ___- -� •� ---------- ------------------------------------------------ ------------- ---------------------------------------------------- Remodeling and/or repairing+(describe):--lf�A--A--- AA_9.1/ -^-_S` ------------------- y i ....................••-•-------•-----------•----------------------.-----•----- ---------------------------------------•------------------------- -•----------••--•---------------------------------•-----------••------------------------------------------------------------------------------------ I,hereb,t tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5t laws,'and rules a d reg ations of the San Joaquin Local Health District. r s n t (Signed)--------- d ---------------------------------------- Contractor) [Plot plan, showing size of lot, location of system i relation to wellspuildings, etc., can be placed on reverse side]. r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ DATE------------ -� l �REVIEWED BY---------------------------------- - --------------------------- ------------------------------------------- DATE------------- --- - ------------------ BUILD ING PERMIT ISSUED------------------------------------------------------------=---------------------------------------- DATE---------- Alterations and/or recommendations:------------------------------------------------------•-•-----------------------------------------------------------------....----------------------......... -------•----------------------------------------------------------------------------- --------------------------------------- ----------------------- ---------------••-------•---------------• ------------•--------- ---------- ----------------------------------------------------------------------- ------ ------------------------------------------------•----------- ------------------------------------------------- ------------ -------------------------------------------------------------------- •---------------------------------------- --------------- -------------------------- --------------------------.I--------------------------------------------------------------------------•-------------- ------------------------------------------------------------------------------------------- FINAL INSPECTION BY:__--- ----- ------ -------------- Date------------------------------------- SAN ------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West.Oak Street 132 Sycamore Streef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100