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APPLICATION FOR SANITATION PERMIT Permit No„� _i!*._ (Complete"in Duplicate) . �. r Date Issue4)_ -t.si•_� r Applica*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 Ordinance No. 549, JOB ADDRESS AND LOCATION.___,ZQ_,X., _.__ __C ------------- ----------------------------------------------- Owner's Name------ R�L�L s f..��-----��----- - i .3-5� 7 I k ------------------------------------ -- Phone- �� Address------- Q.,3 'Z �� - -----•----••----- Contractor's Name-------- ."` /Y� -- -----------------------------g---- r Ph.ne __I;�_4 49 2 i Installation will serve: Residence ApartmenE] i t House Commercals❑ Trailer Court ❑ Motel L] Other ❑ ti Number of living units: ./... Number lf-bedrooms _t3__. Number of baths __g- Lot siz _.jp.6.�/ ��- �_-_-------- Water Supply: 'Public system �Communi jy system F1 Private [❑ Depth to Water Tablfe _4/ ft. k3O Character of soil to a depth of 3 feet: Sand IE] Gravel L] Sandy Loam []''Clay Loam 0 Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑l No ��New Construction:. Yes'❑ No E_ TYPE OF INSTALLATION AND SPECIFICAT11 NS: (No septic tank or cesspool permitted if'pubiic sewer"is'avaiII6616 With''200 faFE.) �p Tank: Distance from nearest well.................Distance from foundation--------------------Material No. of compartment i--------------------------Size------•-•-------------------=---Liquid-depth--------------I Capacity Disposal field: Distance from nearest well._Distance from foundation__.-Q�__ Distance to nearest lot line.-.` -_-...._ Number of lines------/----------- - -------------Length of each line.....-a- -- - --------Width of trench. $�-"__---- �r � t -- Type of filter material5t_1�AEGk-----Depth of filter material___---/y...-..___Total length.___ .Q.-._)------__. _ ------------- Seepage if: Distance to nearest welf -__-_--Distance from foundMion_..,?4._..._.Distance' to nearest lot line.-.�-�_.-._ I�urimber of pits....-__�,......--.__Lining material: '_ �l Size: Dam terfi_ � �` De Depth_- S � i f -t Cessp ol: Distance from nearest well-----------------Distance from foundation.-------- Lining material...................... ❑ Size: Diameter------- -------------------------Depth f-------- ---------------------------- ------Liquid Capacity---------------------------. gals. Privy:I Distance from nearest well------------------ ----------------------- --_..-Distance frore nearest building---' ❑ .....-__.____________-.__- ----------- Distance to nearest lot line - --- ------------------------------------------- Remodeling and/or repairing (clesctibe)-----------------------------------_-----...__.--"'. --7 1.. `" I ----------------------------••---------------------------------- = ------ ------- ------------------• -----:. -------- _. �_... r I hereby certify-that lhave,.prepared this application and that the work will'be dome in accordance with San Joaquin County ordinances, St ws, and )and-re6ulations of the San Joaquin Local Health Dist ict, q ---------- 1 0 Q -� e ( ��"/ �C> 1, �/C- (Signed) ------ --------- Contractor) r on rac ( p By:---------------- .[. ��--__-W..... Ti#le Plot plan.-showing size of lot, location of syste n relation to wells, buildings, etc., can be p aced on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED•BY----- I------------------------- -------------------- -- - DATE--------- �~/ REVIEWED BY------------------------ I � ` ---------- ------ DATE---- --• ---- ----------------•- BUILDING PERMIT ISSUED --- ------------------------------------------------------------- - DATE--------------------- Alterations and/or recommendations:---------------------------------------------------------------------- ------------------------------------ - -----------------•--------------------- ------------------------•- --------•------ -------•------- ----------------------------------------`------ V1FINAL INSPECTION BY: P�i-'�e- :U'-y------------------ 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 I . Revised W-2100