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l Permit No. .__-- 3 -.- APPLICATION FOR SANITATION PERMIT c1Com lets in Duplicate) 1! P P s Date Ise 47 \� u �� r Application is hereby made to the San Joaquin Local Health District for a permit to construct and-install the wor herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__________yP/_Q_ _-- _ s�-st=-- k----- Owner's Name------------ - +rar�A t...?.�e/2�7------- ---- ------------- Phone__, fyvr�-------•---- ------ • •------ Address--------------------- ----------------- CrlG -------- -�------------••---------------------------------------------------------•--•------------------------------------ ------------- Contractor s Name------------------------ OL �: - Ph = Installation will serve: .Residence Apartment House; ��ommercial ❑• Trailer Court' Motel' Other x : R.y Number of living units: ___'Number of bedrooms - 'Number of baths __yLot size _____ � -------- Water Supply: Publics stem Communit -'s stem. -P�ivate De- th to Water Table _ [eft. PIVS_ PP Y� Y ❑ � Y Y ❑ � p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ iSandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No XT New Construction: Yes 21 No ❑ Q TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer I available within 200 feet.) ( r Y 4111 �, Septic Tank: Distance from nearest well_--_.___Distance from foundation__/P-/------ A Septic of compartments-- ------------------Size Liquid depth-.r _-_---Capacity--- BL' y CK Disposal Field: Distance from nearest well_ ti2-___ -.Distance fr7mfoundation_____/_10.......Distance to nearest lot line___ .la [� Number o-i lines---- ----•------- - ---- -----Length of each line__s:,17Q_-_-----------Width of trench_ _4 !_'------------------ Type of filter material_ __p_-_ _ ____.Depth of filter material__._�f k-**'____.Total length_- -T.V`__________________________ Seepage Pit: Distance to nearest well-_VfQ _Dist0ce from foundation---�-----------Distance to nearest lot line__._`- .� Number of pits...._I_------------Lining'�material_ --_-Size: Diameter___ . .'!--------- th_ p ------------------ Cesspool: Distance from nearest..well----------.---- Distance from-foundation__:___"--.-___'Lining material____________________________._--_._. Size: Diameter--------------- - I ❑ Depth Liquid CapacitY-------------- ------------gals. Privy: a. Distance from nearest'well------------------------1!------------------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line----------------------- ------------------------------------------------------------------------------------------------ iI Remodelingand/or repairing {describe)=------------------------------------------------------------------------------------------------ -------------------•------------- ---------------------- 11' -------------•--------------------•----- ------------------------•-------------------------- ••- --------•--- ---------------------------------•-•-- ------- ------- -- . I --------------•--------------------------------------------------------------------------------•---------------------------------------------------..------------------------------- ------ ----------------------------------------------------------•-------------------.--------•---- ---------•------- I hereby cer E y hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la and rules and regulations of the San,Joaquin Local Health District. a Sin 'd �� == ------------------------------------------------------- /or Contractor) g )------------•- !M ------------- B ------------•----- ----------------------- -- ------------(Title)---iE:-z- zA (Plot plan, showing size of lot, loc ion of syst i relation to wells, b ' ings, tc., can be placed on reverse side). Al. FOR DEPARTMENT USE O&Y I APPLICATION ACCEPTED BY---------------------------------------------- --------- - DATE--------------- 2 _. -------------------- REVIEWEDBY------------------------------------------------------------------------ �� ------ --------------•------------------- DATE BUILDINGPERMIT ISSUED-------•----------•-------------- ----•-•---------•---'IM_ -•-------------------------- ------ DATE------------------------------------------------------------ Alterations and/or recommendations:---------------- -----•••-------•--------------•-----------------------••--------------------•------------•----•--------------------- I ---- --------------------------------- q 1t --------------------------------------- 4: --------------------------- ------------------------------- ----------------------------------------------------------------------•--------------------•------- ------ •-•-------------------------------------------------- ----------------------------- - FINAL INSPECTION BY-------------------------- ----------------- ------- Date ----_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100