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V APPLICATION FOR SANITATION PERMIT Permit No. _61_-x.3. n _L (Complete in Duplicate) TN Date Issued .-- . 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 1compliance with County Ordinance No. 549. JOB ADDRESS AND LOCILON... - ______/.d-_--_____._ --------------------- - -------------------- Owner's ------------- -- f Owner's Name ' --••------ Phone ------------------ -=--------- Address.......xi.e.:...-- ------ "^ Contractor's Name ._ _ -- ------------- Phone/4-J"'_�-1 11--- Installation will serve: Resitence A- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_L---_ Number of bedrooms __2_ Number of baths . _--- Lot`size .--7i -_- __2- -=----------------------- Water Supply: Public systaIm �ommunity system ❑ '-Pri+iate'❑ -D'epth.to'Wafer-Table :%45 ft. Character of soil to a dept4 of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Application Made Yes'❑ No A-New Construction: Yes ❑ No I TYPE OF INSTALLATION.AND SPECIFICATIONS: r 7 { (No septic tank or cesspool permitted if public sewer is available within 200 fee!.)- ) Septic Tank: Distancg from nearest well------------------Distance from foundation---- Material----___--'-------__-- ----------------------- No. ---- --------------No. of acompartriments----------------------------,Size -•----------------------------------------Liquid depth `Capacity Disposal Field: -Distant from nearest well---- Distance from foundation----___------0-..--Distance to nearest lot line____--!_----_---_ Numbed of lines------------ ---- Length of each line- ---- --__-_-_.Width of trench---_ -------------_____._-_ -------- Type of filter material-°--.A,_`._--_____ _De th of. filter material-----_-/ f Total len th___-_ Seepage P•f: Distanc� to nearest well----------------- Distance from foundatron___---_- -_--_--_-_.Distance to nearest lot'line-__-__---_--__--_ - Numbej�of pits----------------------Lining material----------- --,'--_-- .Size: Diameter__-----------:---------Depth----------:--------------------- Distance,.Distance,;from nearest wef€ -------------Distamce fromfoundation Lining material--.-_---_-_ ❑ Size: Di'dmeter------------------ ------- - :Depth `; -=--------------------- Liquid Capacity----------------.-----------gals. Privy❑ ll t .. a��- ; ta. '- -- resf building.-';-- :t Distance from nearest yrell________________________________________________D_isfance from nea�� Distanc to nearest;lot'Iine - --------------------------------------------------------- ----- -- Remodeling and/or re' airi�g (describe):_ - 3 ------_. _ ` -- ----- - -- --- ••--- ----•------------------------------ -�3� .. a F r x .. _ �""�-------------• ------------_-----------_-----_ -------- --------------------------------------------------------------------------------------------------- - -- - i r. 7- Orlin ------------------------------------ ---------•--•------••-•------------•--------•----:--------.....----••-•--'----------� - --`-----'-------•------------------------•------------------•----------------------- I,hereby certify-that 1-have prepared this'application and that the work will-be done in accordance with San'Joaquin County antes,2afe laws, an ru s and'regulations of the.San Joaquin Local, Health District. l {Signed} o •------ on act }• fF BY•------ - - -- ----- -- -AIM,----.T--.-�----- -- --------------------------------------------•{Tit e�--��- --"-�----------- ------- - - ----------- -- (Plot plan, showing siie of lot, location.of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY t - jj APPLICATION ACCEPTED�IBY------ ------ - ' ----------------------------------------------------- DATE. .a� _ REVIEWEDBY-`---------=---------11---=---------------- -- ------------------------------• ---------:-•--•- - ------ DATE------ = BUILDING PERMIT ISSUED1k--- ------ --------- i DATE------------ •- Alterations and/or recommendations-------------------- ---------- ------ - - --------- �M ------ V --------------------------- ---------•--•-----•------ • ------------ --------------------------•---#-----•----------------------------•-----------}--------------------------- -..-.- ......---------- ---------------- -------------------------------------- ------------------ 1--- -- - ------- - ; e FINAL-INSPECTION B .!k° - �+ = ------------------•---- 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 Revised W-2100 �'