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Wil( 13 2-C - . APPLICATION FOR SANITATION PERMIT Permit No. /"L,-',/�_� (Complete in Duplicate) /�` s • .Date Issued ---^------------ Zl 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, 00, JOB ADDRESS AND LOCATION------------_-- - - „"a6"� Owners Name-------------- -�•- --rr-------- --•- ---- • - --- -�------ ----- --------- -°Ph Phone Address -- -------------- -----------•----------- ---- ---------•----- Contractor's Name---- p " ��aQ r - # •�o�� =' Y----- --------------- --- Installation will serve: 'Residence partment House ❑ Commercial ❑ Trailer Court I [:]. Motel 0 Other ❑ Number of living units; _1...___ Number of bedrooms Number of baths _. of size ___:•___. - 1-�- 1 _�C.l.-�`T�----------- Water Supply: Public system Community system ❑ Private❑ Depth to Water Table Character of soil to a depth of 3 feet: -Sand 0 Gravel [j Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ardpan E]r Previous Application Made:- es E] No New Construction; Yes f 0 TYPE OF INSTALLATION,AND SPECIFICATIONS: . r ` {No septic tank or cesspool permitted if publicsew r is available within 200 feet.) Fy` .., . Septic Tan Distance from nearest well - d4�- _ istancefromjotindation-ZZP d f No. of com artments__.- ` - p Size_ ,v -----------Li'Liquid de th--- W q p. �1-��------__Capacity---1-'�-Qd-- - Disposal Fi Distance`from nearest weliA/4---_. r i ' Distance from foundatio _ __Q__�___-_.Distance•to nearest lot line_-� �__•- Number of lines__-1. -,�_--_ ---__- Len th of each line___ `g -jr--Width of trench____-- ' Type of filter material-Z.- Depth of filter material--�---5'_.-- -,__-Total length_______. Seepage P Distance to nearest we11��' Di to cue to nearest lot line__S� �+ Distance from foun ation__ ----------9-1'- R Number of pits_ ,.t�1�:&_Lining material--�� $ize. DiameterJ�'�_ � / � � � Depth -�Q--- F a -Distance from foundation_____________ �,I,r7Vin j material. 0 �- ---------------- Cesspool: Size: Diameter_nearest well--------------- ---------- -------------------Liquid Capacity_..-•--------------------'--gals. Q Privy:l Distance from nearest well.._._---------------- ------ - _ Distance.from nearest building. _ �, 9 . -- -- --- --- ❑' Distance to nearest lot line _ ---- ----•-- ------------------------------------------------------- ----- --- --------------------------- - - ----------------- Remodeling and/or repairing (describe):__-___ __ Q 1 ' - --- -•--- - _ _______V-_�-•- .___•_ moi------ -------____` p4 t----------- - 7anlo- ___________________________________________________________ I hereby certify that'I have prepared this application and that the work will`be done'in accordance with uin County f ' ordinances, State laws Wand rules and regulations of the San Joaquin Local H lth District. a -_--{Owns and or Contractor f By:. ( { -------------------------------------------------------- Title)----- ---------------- - (Pl ot plan, showing size'of lot, location of system in-relation to wells, buildings, etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY J e APPLICATION ACCEPTFD BY__ --------J: ----------------------------------------------------- -------- DATE---r ---------------- REVIEWi D BY-"------------t------------------ ---- I -------------------------------- ------------------------------------------------- ------ DATE----�--------- ----- BUILDING PERMIT ISSUED - LL ------ ,.:, _ - ---------•--- DATE + , aerations and/or recommendations:__ ______._._ r ---------------------------------------------- -- ------ •---- T '--------------------- ,------- ----- ---------------------------- ------------�. ,( i--------------------------------------------------------------------------- --------------------__------------------------------------------------------------------------------------------------------------ --------------------------------------------..___..___.-_______..-___-..________..._______---_-_____-________ _ _ I ------•--------- ---------------- -------- -------------------------- - r ------/ ------------------------------------------/` ate-- ---------------------------------- FINAL-INSPECTION -----------FINAL'lNSPECTION BY------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak Street 132 Sycamore Street " 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100