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APPLICATION FOR SANITATION Permit N ATION PERMIT a miff No_ _ __ _ ________ cl-OA i f (Complete in Duplicate) r c/ / Date Issued ___ yt -T/�/5.3 pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This This application is made in compliance with County Ordinance No. 549. I fI JOB ADDRESS AND LOCATION__ 0 7 � Owner's Name-------------------M.J 1-----////// s _,09 ' ��5-�;�/ ------------- ---.-- Phone.=��Q��--------- i Address--------------------------------�-7&10 ' .[ 1' _ _ - _ aTContractor's Name-------- ----- ----� � �-��- ----"`--��!-------------- -- ---------------------- •-- • ------------_ Phone--�7._=---• -- ------ ------- Installation will serve: Residence Apartment House Commercial Trailer Court p ❑,,f ❑ ❑ Motel ❑ Other ❑ I�Number of living units: __/----- Number of bedrooms _Y___ Number of baths /...... Lot siie+=70r..-_SC- Water Supply: Public system $� Community system ❑ Private ❑ Depth to Water Table 9S ft. CharacI�ter of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay❑ Adobe 0� Hardpan ❑ 4 Previous Application ade: Yes ❑ No 0 New Construction: Yes ❑ No TYPE OF INSTALLATIO;: AND SPECIFICATIONS: 1, "1%, septic tank or cess�ol permitted if public sewer is available within 200 feet.) S ptic,'Tank: Distance from nearest well_________________Distance from foundation--------------------Material ___--__________________-.-.___.._-_-__________. ❑ '�, No. of compartments---__---_ ___Size------------- ..Liquid depth--------------------------Capacity __-___ Dispos l Field: Distance from nearest well_1W.H9"_Distance from foundation---14- ----- Distance to nearest lot line_-- -----___. �S Number o-i lines___-_/_____-- _ _._Length of each line—S-0 J1 'd " WI th of trench- �pG Type of filter material.._ ,�__ _Depth of filter material--_, _________Total length-___ __.-_-_-____-_______--___--_- Seepage Pit: Distance to nearest well------------_---------Distance from foundation--------------------Distance to nearest lot line_-_-_---_____--__ ❑ I 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-----------------------------------------. ' ❑ I Distance to nearest lot line-- ----- ----------------------�------------------------------------- = j Remodeling and/or repairing (describe): -r'---`--------------------- ------ --- ---------------- ---- -----------f----•------------------------------------------•---- �-- 6,.5 �� ,_�-_ te t ---------------- ---------------- ---•--•---- ------ .------ ---------- ----y - --- -- --�-------------- - ------._-- 11 I hereby certify t ve prepared thisapplication and4at the work will be done in accordance with San Joaquin County ordinances. State law , nd r les and regulations of the San Joaquin Local Health 16istrict. S� ned ig } r (Owner and/or Contractor) + - -- ------------------- -- BY= - {Title) (Plot plan, showing size o lot, location of system in relation t wells, buildings, etc., can be plaUd on reverse side). I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- •- --------------------------------------------- -------------------------•-------------- DATE- REVIEWEDBY - ---------------------------------------- - ------------------------- DATE-------c�------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE..---- ------------------------------ -------------- Alterati1_1 �ons and/or recommendations.-_ -------------------------:--------------------------------------••----------------•---------------------- i IS ------------------- I ---•--------- ------------- ---------------------------------------------- ------------------- -------------------------- - ----------------------------------------- -------- -------------------------------------------- I1 - ----------- FINAL INSPECTION BY:----------- -----------•---- Date----------- ` y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street IIStockton, California Lodi, California Manteca, California Tracy, California I I E$-9 F 2M 10.52 Revised W-2100