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„✓� _ APPLICATION FOR SANITATION PERMIT Permit No.1_A# -Q_____ l vN' 1 (Complete in Duplicate) 9_ j�✓ Date Issued ,application 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 Ordinance No. 549. JOB ADDRESS AND LOCATIONJZ/d-_ _a.c�G__✓t_°�IIM1��7” 0---J-U-Zq_I_//-Qs4x_-5-}-------------------------------------------------- Owner's Name--- ...... T}l_ Phone__s " --------- Address........---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- /> r // Contractor's Name__C.FII _.1 _t11 _ ----7-e -cra.c,=� -----/ G-------------------------------------------------------- Phone__r�`_�f��_0_ ------ Installation will serve: Residence �, partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i r Number of living units: _/-____ Number of bedrooms ._;3_ Number of baths __1___ Lot size7v__�_/?A�, _1_:'S�1_�___ Water Supply: Public system �Community system '❑ Private ❑ Depth to Water Table- .__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay F] Adobe 2��ardpan ❑` f Previous Application Made: Yes E] No �ew Construction: Yes 2"N1 El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifewer is available within 200 feet.) i Septic Tank: Distance from nearest well-=--Distance from foundationllJ_1---------- .Material_�f_�1Gl No. of compartments____-Z-------- _ __ _______Liquid depth_____�1_' __________Capacity___ 0 � A42d-Distance from foundation.-1:89 Disposal Field: Distance from nearest well__ i ..___.___Distance to nearest lot line_.0_--______.. Number of lines.------�-----------------------Length of each lin�V__4W_f*7__.6Q`_.Width of french----------Z�"______________ Type of filter material�_-_ Depth of filter materiaL__! ---------Total length---ff7��__________________________ 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----------------------------------------- F1 ______________________________ ---__.__. ❑ Distance to nearest lot hne---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) NCir - I =`7 �. ✓Zs---------•----------------------------------------------------------------•-------•---•-------- --------------------------------------------------------------•--------------------.------------------------------------------ ---------------------------------------------------------------.-------------------------- ------------•----------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rules and regulations of the San Joaquin Local Health District. �I ✓ z (Signed)------ -,_Gi,. _ _ � Owner and/or Contractor) --------------------------------------------------------- OYs—:---- - - -------- - - --=----------•------------------------------------- - ----- ----------(Title)---- -------------------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-- DATE-_ �� -------------------------------------------------- REVIEWED BY----- •----------------------------�------------------------------ - -- -- --------------------------------- DATE ----�---------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ -'e----------------- -------------------------- Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------•---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------- --------------------------•----- -----------------------•---------------- ----------------------------------------------------------------------------------------------------------------------------- ------------------.. ---------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------- -----------------------•------------•----------------------------------------- ----------------------------------------•-------------------------------------------------------------------- F1NAL INSPECTION BY_______________ ____ _______ �� :� �------------------- 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 I —.