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_ �APPLICATION FOR SANITATION PERMITB Permit No. _211_.__ _ (Complete in Duplicate) Date Issued ----- Application is hereby made to the San Joaquin Local Heal strict for a ermif to construct and install the work herein described. This application is made in compliance with County Ordin nce No. &4 . JOB ADDRESS AND LOCATION -- - ------ ''.---------------•--`-------•------- Owner's Name------------------------------------- fi-------- ---- ---------------------------------- -- Phone----59g_7-6-1-------- Address-- ----------------- ------------------------ I--------•---------------------------------•--•--------- ---•---•------•-------- dL Contractor's Name - -----`-- EJ2.�.. ...r_ ------ Phone------f— f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Co- rt ❑ Motel ❑ Other ]. Number of living units: __1_ Number of bedrooms _94. Number of baths -__- Lot size ___ D_'Y_ _/_d-70__x_________________________ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table A/Off. r' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Application Made: Yes ❑ Noj< New Construction: Yes' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if, ublic sewer is available within 200 fe t.) E Septic Tank: Distance from nearest well_______________Distance from foundation___ ______________.Material___________-______ No. of compartments___.__-_ ---------Size__ __ _ Liquid depth_ '-__-___-___Capacity Disposal Field: Distance from nearest well--.---------------Distance 134from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------._-----•-----------_--- Type of filter material-------------------------Depth of filter material-----------------------Total length-----------------------------•------------ So ----------- ; Se1(1 epa a Pit: Distance to nearest well__`-__Distance fro foundation.-�-4 _:_.-_.Distance to nearest f t line... Number of pits_____6_______________Lining material�� Size: Diameter_- `� De th__r�_,r"-_______--____ p Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material_______________--____________----_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------- ----------------------------Distance from nearest building------------------------------------------ F • ❑ Distance to nearest lot line- ------------------------------------------ ------------------------------------------------------------------------------- ------------ I Remodeling and/or repairing (describe):------------------------------------------------------•------------------------------------•---•------------ •-•-----------------------------•---•----- ----------------•-•----------------------------------------------------------------- ------------------------------------------------------------------------------------------- -•---------------•------------------- I --•--•----------------•------------------.....------------------------------------------------------------------------------ -------------------------------•----------------------------------------------- - -------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------•-------•--------------------------- I hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinances, State laws, s and regulations the San J quin local Health District. (Si ned ---- g } ------ ------{Awne +esl-Contractor) B.Y�'= - ^--------L=�----�'-`- ---------- (Title) �' '.�- c. I---------------- `' (Plot plan owing size of lot, location of s st m in relation to wells buildings, etc. can b pt ed� g , e p ced on reverse side). 1 FOR DEPARTMENT USE ONLY i _. APPLICATION ACCEPTED BY --- -- - DATE- , Yom' REVIEWEDBY------------------------------------------------------- --------------------------------------------------------------------- DATE--- ` BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- ----------- DATE------ ------------------------------------------------ Alterations and/or recommendations--------------------------- ----------- ---------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------;------------------ ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ---------------------- -------- -------- ------------------ ------------------------------------------------ -------------- -------------------------- FINAL INSPECTION BY:---------- - ---------------------------- 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 8-51 Revised W-21 do