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APPLICATION FOR SANITATION PERMIT Permit-,No..____ _________________ (Complete in Duplicate) pate Issued ___._1/-S 3---- I Applica+ion is hereby made to the San 'Joaquin Local Health District for a permit to constru d"nd7iWthe work herein described. ./ This application is made in compliance with County Ordinance No. 5 9. JOB ADDRESS AND LOCATION__ -- --------- -- --- - �17--3•- --y-.-- ----- ----'--- ----- -------------------- i Owner s Na-m-'e- ,: ' _ Phone Address---�p FS _c__--- ------- - -' Contractor's Name____ --------------- -- -------------- -------------------•----- Pha ` of Installation will serve: .Residence E] "Apartment House ❑ Commercial E] Trailer -Court otel ❑ Other ❑ Number of living g- q units:rJ- _ Number of bedrooms -------- Number of baths __ Lot size ----;__�--_ Water Supply: Public system ❑'- Community system ❑ Private,Depth to Wates Table _jP'rft. ? Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Cl, Adobe 4 Y ❑ Hardpan ❑ Previous Application Made: Yes ❑ No P4.�_ New Construction: Yes 61% ❑- _ TYPE OF INSTALLATION AND SPECIFICATIONS: µ ... ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well--f _-•-_--Distance from foundation:____� -. �� ,�- / Mate lel -- -------------- E4— `^ No. of compartmenfs--------- ----------- 4-----5 =' ^^ Liquid' de th-___d------- -----Capacity- ---Size__ -- G p - -- - Disposal Field: Distance from nearest well__..7_-""__-__.:Distance-from foundation___-1_b._.___._.Distance to nearest lot line._1 ---•---- „� :..= !Number of lines---•-- --�-- Length of each line------1__Q_d_-�`__--.Width of trench.. _ _______-_""-_"-"_- --- Type or;filter material_: .C_ ��--k__Depth o r erial----� _•�_-----Total length--.--- --(�-0 { _ r�/) 4. 6. —er'o x Seepage Pit: Distance to neall__- O - i . .�, ante rom f urid tion___.__ _Q.._____.Distance to nearest lot line__._`_ Nrumbe'r of.pits ----- --L?Hing terial--,r - -- --- ------5 e: Diamefier- ` Depfn._:,,2"-�1-------------- r Cesspool: Distance fromell_________________ istance from`fou ati6n----------------------Lining material.____:'_"-"_______________� l� ❑ Size: Diameter----- - '' th t gals. s ----Li uid Ca cr _ q Pd •tY Privy: Distance from nearest:vrell: -"---------- ----- - Distance from nearest building--------------------------- ar , y . Distance to nearest;lot line--�----1�- -,='---------- ---- �--°---------------------------- ---------- - . , 1..:.._�_ Remodeling and/or repafrrng -(describe]:___ ___ �m't� _- .r? _* 't h ,j # - �'+ . _ I --------------------------------- ------------------------ ------------------------------------- •---• -----------• ----------------------------------------- ---------------- ----------`----------'- ---'- -I_herebycertif that I have "` y� prepared this application and#hat the work will be done'in accordance with San JoaquinYCounfiy otdinances, State laws, and rules and'regulations of the,San Joaquin Local Health District. L .. cS - ------------------------ . . �2 y r Contractor)r)(Signed)--- t� 11'BY --- T (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). � r . F w FOR DEPARTMENT USE ONLY T APPLICATION ACCEPTED By ------- ------------------�. ^� `+d r ' - �---_ DATE "'--------- ' REVIEWED BY_----------------------------- 1- ._... _ - 1 � --- --- DATE---".------------'-------•-------••------------------- "" BUILDING PERMIT ISSUED-------------------- ---------------------------------I w.� Iterations and/,or rec mmendations:.�tVv i = x - - - --- -- I F ' /rr .. (y-� � --- ------ ,�A,f . . :. .. -- --------------- -'•>'_�:` t _ r4 -------- ..,, F1NAL INSPECTION BY:-----._...... -- - `� i C� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street M North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 9 —2M Revised W-2100