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rK APPLICATION FOR SANITATION PERMIT Permit No. ___ __ 7-.. (Complete in Duplicate) �/ r Date Issued '1«/�3,_. Applica¢ion 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 compliance with County Or n No.;54lL JOB ADDRESS ANDILATI N __ � CI1Z4 —� •------------------ -------- -- Owner's Name----------- -------- Phone `------Address•------------•-•------- ----- s _ r: : I Contractor's Name---- 11 ------------- k -----------------•--�tt_��: -------��C..r-------------------------------------------------------------- Phone Installation will serve: Residence M- A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number.of living units: _4 Number of bedrooms __Number of baths ---e�_ Lot size - Water Supply: Public system 2__�Community system ❑ Private ❑ Depth to Water Table ?ft. 4, Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam El Clay am ❑ Clay A be Hardpan ❑ Previous Application Mader Yes E❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet:I e tic. Distance from nearest well--------_--------Distance from fodndation________�-_-_____.Material sal el�`� o. o compartments--------------------------Size------- ------------ - - ------Liquid depth-------------- -- - --- Ca Capacity Y-•-------3 s -------------- Die.from nearest well-----------------'Distance from foundation-------------------_Distance to nearest lot line--_.___--________ �> j��iumber of'lines-----------------------------------Length of each line------------------------------Width of trench-------------------- ----- Type of filter material_________ ______________Depth of filter material-----------------------Total length------------------------------------------- Seepage __---______-________--_____-__ ' p 9 --- .1" Distance to nearest lot line___ Number of pits- -------- Lining material _ --_- ------- ___.Size:,-Diameter__- f� -Depth. - ----------- Cesspool: Distance from nearest well------_-------_-0 Distance from foundation------------------- Lining material__.__---.______----------------------- {\-, "U ❑ Size: Diameter------ F-----------------------------Depth---------------------------------------------------Liquid Capacity - gals. Privy: Distance from nearest weft----------------s-.______._._ Distance from nearest building 4 ----------- ------------- --------------------------- ❑ Distance to nearest lot,line-------------- ' - -------------•---------------------------------------- Remodeling and/or repairing (describe):_-- _____ , _- _`"'- x � Y� , - -•---------------------------------------------------------•----------------------- --------------------4----------------r-------•--------- --------------------- ----------------------•--------------------•------------------------------------------------------.---------- =------------- -------------------------------------------------•------------It------------------------------------------- --------------------------------------------------------------------------------- I I hereby ertif that I hav prepared this app ati and that the work will be done in accordance with San Joaquin County ordinances, St ar w�s, ands rul and re ions o th an Jo quip L cal Health District. L (SFgR@dJ--- ----yL -�- ---:-- •------ - ---- --- w-r I — v By:---------------- Con}tact ----- ---•-- - - --------- -- ----- -------------- ----- ------------•-------- Title_ ` or I Gam- ------- (Plot plan. showing size of lot, location of system in r I tion to wells, buildin s, etc., can be aced on reverse side). FO DEPARTMENT USE ONLY i ACCEPTED BY APPLICATION -------------------------R--=-- - -- ------------ - _ A DATE _' REVIEWED BY -------- -- -------V------- --- ------------- -------------- / --------------- ----- - DATE---- ------ -€--=---. BUILDING PERMIT ISSUED------------------------------------------ ----.- DATE.------------------- - A terations and/or recommendations:_______________________ ------------------------------------------------------------------ ----- ----------------------------------------- ----------------- -------------------------------------------------- FINAL-INSPECTION-BY:.- ------ ----------------- ---------------- Date..- ---. - ------ -f-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-97-2M ; IRevised W-2100