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Via`* 4�APPLICATION FOR SANITATION PERMIT Permit No. _...- - (Complete in Duplicate) / Date Issued Application 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 compliant %�,Ou # rdin a�Vo. 549. �- ICC33�o ��, ,p � y .JOB ADDRESS AND LOCATION".. .:-------:------------��'----- -��l�-D--------•-----------/`z/{"!I��C Owner's Name----------------------- s# f� 7C. i -- ----------- Phone4k_' ti E Address -----U�'C� G �C7 -)------•-------------------------•---------------------------------------- Contractor's Name----------------- ----- Phone------------------._---- --- Installation will serve: 1 Residences, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E {. Number of living units: Number of bedrooms _3-- Number of baths Lot size -------f-7- - -_-1 -2 ------------ Water Supply: Public system ❑ Community system ElPrivateAr Depth to Water Table/--ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam N( Clay Loam [I Clay ❑ Adobe ❑ Hardpan ❑ previous Application Made: Yes E] No � New Construction: YesX No ❑ tIC7� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest weft--- __--Distance from foundation_---�Q--------Materia _-. �— �C tX:�__Liquid depth----------- -------------Capacity---------- -O No, of compartments------ ---- $ Disposal Field: Distance from nearest well____9!9~ _.Distance from foundation---- lU Distance to nearest lot line------*it Number of lines----__.__- -_-- - `Length of each line--------_-.�U--�[------Width of trench.-----.-----2�--of-.~------ Type o f filter material_�'° ----------- ------Depth of filter material------le_---------Total length Seepage Pit: Distance to nearest well----------------------Distance from foundation_________-----------Distance to nearest lot line-------.--------- ❑ Number of pits---------------------Lining material--------------- ----- Size: Diameter-----------------------Dep1h---------------------------------- Cesspook Distance from nearest well-----------------Distance from foundation._..----------------Lining material--.----------------------------------- El -.--.--------._-----.❑ Size': Diameter------------------------------------'De pfh----------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building --------------.---.--__--- -------- ---- --------------------• ------- ❑� Distance to nearest lot line--- =----------:---- ----------------------------------------------------- ---- -------- Remodelingand/or repairing,{describe):--------- ---------------------------------------------------------------------------------------------•----------------------••------------------.----- _______________ ___- ------_--_____----.--_--- ----_--_____-_-_.__--�r--______--._--___-__-__._-__-_.---_--_-------__-_-----_--. _._ --------------------------------------------------------------- y� i ------------------------ i I hereby certif at i have*prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a and, ul a regulations of.fhe San Joaquin Local Health District. - _ Y ii R Owner±and or Contractor) f / = BY:--------------------------- ----------'-------------------------------------------------------------------- ----------.. .(Title)---:----------------- .r (Plot plan, showing siie of lot, location of system in relation to wells , buildings, etc., can be placed on reverse side). 4 ka w v - FOR DEPARTMENT.USE ONLY , APPLICATION ACCEPTED BY------- ------------ --- --- --- --- -°-------- DATE ! REVIEWED BY - =- -'---- -------------------------- ___-_-DATE----- __ o---I - BUILDINGPERMIT ISSUED--------------------------------------------------------- ------------------------------------------ DATE---------------------------------------------- :---------- -- Alterations and/or-recommendations:--------_-.--. _-.- .-- -..... _.---------------- f --=�-` ------------ --------------------------------- ---------------------------•-------•------------------------- ------------------------------------------------------------------------------------ --------------------------------------- ---------------------------------- ------------------------------------------------ - ------------------ -------•--------------------- ---------------- FINAL INSPECTIONBY:---- .1_. ------------------------------- e " Date-- � h�1 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 t.. .- ES-9-2M 10-52 Revised W-2100