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JY � '-.. L II 1 M s APPLICATION FOR SANITATION PERMIT Permit No. ..... __..__.... .p �/ [] (Complete in Duplicate) 7Ts • Date Issued )i-cation is hereby made t! the San Joaquin Local Health District for aer ' This application is made in compliance with County Ordinance No, 549, p mit to construct and install the work herein described. i I� q JOB ADDRESS AND LOCATION---,----- ----------------- Owner's Name---------- c' ---------f.10...f Z ------------ _- � - ----_-----. -,->---------. ---------- Phone- ----Address---- ------------_ - ----- - - ...__!7_v ----cL -a-�------ ------•--------------•----- ------------------------------------------------------------------------------•---- Contractor's Name ' !:., - M' ---" -n!C-_ ,i Phone._ _ -6. ---------- Installation will serve: Residence [A fApar#ment-House-E]—Commercial ❑ Trailer--Court ❑ Motel ❑ Other ❑ Number of living units: _f____ Number of bedrooms : '„ - Number of baths --/_-_ Lot size ___''�67--� . dr y fp--•-•-------------•- Water Supply: Publics stem Community system ❑ Private ❑ Depth to Water Table M6_ ft. Character of soil to a depth of 3 feet:i Sand ❑ ?Grave ❑l ,-Sandy Loa ❑ Clay Loam [jClay [] Adobe ® Hardpan E] Previous Application Made: Yes ❑ No New Construction: Yes 91 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well: � ''Distancetfro in foundat��n__119___-____.Material-_�f---4 G� No. of compartments_. -__. -------------5ize& E_�"_,f_ - -_ -Liquid depth--- ."-------Ca p Y ; Disposal Field: Distance from nearest well_________________Distance from foundation-------------k------Distance to nearest lot line----- El Number 0.41Ines-------•---;-----------------------Length of each line--- = Width of trench. Type of filter material-'-----------------------Depth of filter material_--------,-------- ------Total length-------------------------------------- Seepage Pit: Distance tdnearest well---41&N_/ Distance from foundation----3Q'_____.__-.Distance to nearest lot iine_._fQ_�___ ® Numberaf;�pits-- Lining material--(C Diameter ---------Depth - ... h Cesspool: Distance fr9rn nearest lwell-----------------Distance from foundation------------------- .Lining material-__.__._.--_-_______ �J ❑ Size: Diame`ter--------------------------- ----- Depth ---------------•----- ----- rn II % -- - - -----Liquid Capacity- ---- ----------- - gals. al Privy: Distance from nearest well ________________________________Distance from nearest building ' - g ------------------------ -- ---------------------------------------------------------- - Distance to'nearest loft:line______ - �� --------------•-------------- Remodeling and/or repairing (descriEye)____ ----________________ __________ # _ ----------------------•-------F-------------------- L _ _________________________ 1r _________________________________________________________________________»__--__.___..______._ -------- ------------------- i _____________________________________________________I_____-________ R ____.__._ ___________________________________________________________________�___..._____________.______________._________.__ ___._ hereb certify that lhave - Y y prepared this-`application and that the work will be done in accordance with San Joaquin County { ordinances, State laws, and rule's and regulations of the San Joaquin Local Health District. (Signed)------- / --_.�i- ,_f�7_!`S'H S� se"Ovs Z"MC- (Owner and/or Co t - __.____(OwnContractor) By: ice- - I x = (Title)- of -. ---------------- of plan, showing size of lot, location of system"in relation to wells, buildings, a#c., can be place on reverse side). FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY_.�_------------------------- - - - DATE ---- - BUILDING PERMIT ISSUED -------------- • ---- - --- -. DATE REVIEWED BY_______ -------------- DATE_.- --------------------------------- Alterations and/or recommendations:------- ______________________. - -------- ---•--------•----•--- ----------------------------•--------------------------------•-•- ---- -- - --------------------------------------------- - ------------------------------•----------------------- -------------------------------- --------------------] ---•-------••-•-------•- --------------- - ------------ ---------------------------------- FINAL INSPECTION BY:.-------- --- ---------------- Date---..---------- 3 SQL SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street p 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-2M t0-52 Revised W-2100 I �P