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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicafe) .. � . � .^..�. ,, •,•�,,,• � , •, bate Issued Applica ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. a This application is made in compliance with County Ordinance NH)) 549. } JOB ADDRESS AND LOCf,ATION... Owner's Name---- __`. ` - - J i F Phe � = one - ---- �- 4 ----- ----- Address �-'--- ------------ --- ------------------------ --------------- Contractor's Name.--IA- - - -------- 1 R Installation will serve: lResidence ❑ Apartment House- Commercial ❑ Trailer Court ❑ Motel ❑ Other []. --- Lot�size ------ --1 --• I Number of living units: __ __ Number of bedrooms __ . Number of baths �d� Water Supply: "Public system Community system ❑;- Private ❑ Depth to Water Table, ft_ ' Charakcter of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam,❑. Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No e TYPE OF INSTALLATION AND SPECIFICATIONS: 4. + (No septic tan or cesspool permitted!if public sewer is available within 200 feet.) s �# n nce from nearest wel ------------=Distance from foundation_______..-________-Material_______f------------------------------------ W. ___----_-__-----__ _ � �Septic -�. of compartments--�_- ----Size----__-_-- ------Liquid,depth--------- ----- -------(Capacity_ ----------------- Dispos Field: Aja .e from nearest .well_________________.Distance from foundation__---________----- Distance to nearest lot-line___,_-_______-__. Nut r of lines----- Y_ ....................---`Length of.each line--------------__.,-____- --•--Width of trench.------------------ ----.- "f # ---------- Type _Depth of filter material---------- -- ------Total 'length__:------------------------___t--_____•_ Seepage Pit: Distance(to nearest,lwa : I� 3istance,dfrom faunc�ation__ v .Distance Jo nearest lot line___ Number of pits_-___ --------Lining material.& : Diameter______, . Depth 's �1 j p # y p I ... . . -Lining material- - .. Cesspool: Distance fro, e __ ❑ Size: Diameter_ E = Depth == m nearest'well______________ - ----- - - `--;-Liquid Capacity-.----------------• ---gals. � istance from oun ation-_ Privy:I Distance rorty nearest well________ _______:_:__ _:�_-__ Distanc from nearest buildin r ' T. . t F _. ❑ i �.., Distance`t0 nearest lot line.-"---- -------------------- _- .._ _,. -.d9. .,. . Remodeling and/or repairing (describe):---------------------------`--------,---------_-_-_-_•--�-----_ __ __ - { --------- ____________________________________________________________________________ _______________________________________________________________________________________ ____ I ; - y f * _-________-3-_- r I.hereby ce i y t at I have prepared this application and that,the work will-be done in accordance with San,Joaquin County ordinances, # fe law , and'rules,and regulations of-the San Joaquin Local Health District. r - (Signed) --- ------- - and/or ract ( _ - _ ______________________(Ow rCont or _-------- ' -------- -------(Title)----- -- - r (Plot plan, sing size of lot; location of system in relation to wells, buildings,.etc., can be placed on reverse side). I t. . t FOR DEPARTMENT USE ONLY" � APPLICATION ACCEPTED BY-------------- -------------- = --=----------- ---• --------- -- DATE----------�--------- --------------------------------------- - -REVIEWED BY 13Y --- - --- --------- ' = '= `- DATE----- -- BUILDING PERMIT ISSUED= k . t------------------------- --------------------------- DATE - ------------ , Alterations and/or recommendations .____-_ ____ _________ __ _�_- -•----------- - ------------ ------------ ---•-- --� '' ------- -•-----__----- . . « - - � ---- ------ _ ------ = ----- e---------- ------ y - ------ - -- -, 1 i : !j__ FINAL INSPECTION. BY: -Dae-- 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 ,—2M : ' Revised W-2100