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,rr x APPLICATION FOR SANITATION PERMIT Permit No. -----_---------JT�¢ (Complete in Duplicate) Date Issued .3-`,_�_�_'�-� Applic tion 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 compiiarrce with County Ordinance No. 549. JOB ADDRESS AIJD LOCATION-- -- er ---------WA_ -4W------ -� ,�_�}_-_-""`"-- _. �_ � �T---- Owner's Name---- �- 7-21-Mr �F------ ----------•------------------------ - -------------------- ------------------------------- Phone�'__!__I --------- Addressr D ----------- f1-T _ 1 `t b-------------------------------------------------------------------------------------- Contractor's Name-- �_--17.1--____ -d1 _ -------5 - a,[ ------- 1Fis----------------------- Phone---c_-'�lC! Installation will serve: Residence Apartment House Commercial Trailer Court ❑ P ❑ � ❑ Mote! ❑ Other ❑ Number of living units: __...Number of bedrooms __.Number of baths -_______ Lot size Water Supply:Supply: Public system ' 4 Community system ❑ Private ❑ Depth to Water Table I 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 SPECIFICATIONS: 114 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4_nk: Distance from nearest well________________Distance from foundation--------------------Material _____. No. of compartments--------------------------Size--------------------------------Liquid depth------------ -------------Capacity..--------------------- i Distance from nearest wefi_./VQNE_._Distance from foundation_ __,AQ_--_.____Distance to nearest lot C2_IS( line_��_�_____ Number of lines____-- 4�_____ Length of each line_____________Len _ 9 -�-----------------Width of trench_��_�:----- - ----------- Type of filter materialj� i---ifPC_K,___Depfh of filter material----Z �r___.___-Total length---------- '--0__----------------------- Seepage Pit: Distance to nearest well_./KeiR_ -___Distance from foundation__/Q---_-------Dis} nce to nearest lot line-- _______ Num11 ber of pits__L�/�'ME________Lining materiai__�_�__li I C/C_-Size: DiametergA_____________-Depth._,�r'�__________________ Cesspool. Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------- 't ` ❑ Size: Diameter`----------------------------------Depth----------------------------------------------------Liquid Capacity------------ gals: II Privy: Distance from nearest well________________________________________________Distance from nearest building--------------------- ❑ Distance to nearest lot line---- --------------- Remodeling --`- ------ Remodeling and/or repairing (describe)---- ------------ ��1`'-------- --------` -----•------------------•------------------------------------------------•-----------------•-------------•--__--------------------------.---------------------------------??_�/ - ---••--------------------------------- r ---•----•----------------------------------- -----------•---------------------------•---•----•---------------------------------------------------------------•--------------•----------------------------- a ---------------•--------------------------------------------------•-------------------------------------------------------------------------------------------------•------------------------------------------------------ I hereby certify that I have prepare,Fl..this application and that the work will be done in accordance with San Joaquin County { ordinances, S e laws, and rules and r ulatlons of the San Joaquin ecal ealth District. F (Signed)------- ----- T, ------ a - - -- - -- --- � - ------Owner nd/or -ortfractor) BY -----------------------------------(Title)__ ----------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placid on reverse side). 1 FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED SY-- DATE__ --=-------------------- �. REVIEWED BY-------------------------------�--- � ---- ----------------------------- - ------------------------- -__ DATE---�. ------------------------- � -- ' BUILDING PERM jT ISSUED----------------------- ----------- - DATE ! Alterations and/or recommendations------------------------------------------------------------------------ ----------------------.--- E. ---------------------------------------------------------------_--------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------____------------------------------------.------------------------------------------------------------------------------------------------------------------- --------------------------------:------------------- -------- _ ___________________________________________________________________________________ _.__ ____ _ _ 1 FINAL INSPECTION BY: -- ------------------------------ Date .. �'xr... . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 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