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� e - 1P(/ APPLICATION FOR SANITATION PERMIT Permit No. _ �__�T-/_Q (Complete to Duplicate) DaTe Issued _ Applica¢ion is hereby made to the'San Joaquin Local .Health District for a permit to construct and install the work h n described. This application is made in compliance with Count Ordinance I!o. 549• l _ } -------------------------- JOB ADDRESS AND OCATION... -- ---- ---�!_ �'Ql1I�_I�----ir-••-------- --- ---- -`�"`r--"rf---•------------=------------- 8"Kne----`•-V_ U�Q• -( xns-'e.�_�---------------- - -- ---------._._. Phone------ Owner's Name-------- --- -------------------- -- Address-------- --------------P-- ---••- -------•----•-_ •----------------•-•- Contractor's Name �c Phone------9n! ----1--�-�---' Installation will serve: Residence OL Apartment House ❑ Commercial ❑ Trailer.Court E] Motel ❑ Other ❑ i Lots�zeYNumber af.baths --------------------------- Number of living units: __1--- Number of bedrooms _ _'� Water Supply. Public system�X - msystem ❑ Private ❑ Depth to Water Table .44pff. Character of soil to a depth of 3 feet Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe , Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes X No ❑ C TYPE OF INSTALLATION AND SPECIFICGA.TIONS: # (No septic tank or cesspool permitted if eublic sewer is available within 200 feet.) o ---_Distance from foundation.�. ---- pac.___. ___ No. of compartments_:�__:_._ --__-__-__SizeJ'�.4__X_�__._A----Liquid=depth__ �...____.____Capacity----x _ ,S� Disposal Field: Distance from nearest v✓ell_dQ(to?_.-_Distance from foundahtion,�..Q____----------Distance to nearest lot line_.;r `7.._ n Number of lines------ ----------_--------------Length of each`line_2-Or---------------- of trench___.:�_V!L! --_____________-- -. [Depth of fi§ter material___/00"-_t-----Total length_____l9tQ�_________________________ •Type of filter material _ p - r-' � �.. IM. A--- �... - �4 0. Seepage Pit: Distance to nearest well_04ft __._,' _Distance frocn f undation_ . _D_..:-._..Distaa to nearest lot line___��-- Number of pits___ ___Y_ Lining material__ __-Size: Diameter__, -____.____.Deptn__ ____________________ ....a ' Cesspool: Distance from nearest well_TM_"�----------Distance from foundation................. ..Liriirig material_-_._--_'_-__.____.____._________.._. ❑ Sizer Diameter-------------------------------------'Depth------------------------------------- --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------_---_'I�---------------------Distance from nearest building_ ___-______-________---.____-.____------ ❑ Distance to nearest lot lire---------_----------------I--------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------ -----------------••-•--------•---- ----------------------------------------------•-------._....------------------- ----------------------------------------------------------------------------------------- --•-•-------••----------------------------------------•----• -------------------------------------------M--------------------------- ----------------------------------------------------------- IM -------------------------------- -•-------------------•------------ 11 -------------------------------------------------•----------------- --------------------------------------------------- -• --- - I hereby er 'fy fhat I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, Sf to aws, a rule and regulations of fhe an f oaquin Local Health District. I {Signed].--------- - - -- -- --- --- -------------------- - ------- --------- --- ------------- -------------------------- ----- � Contractor] By-------------------------•-••--------------------------------------------- ---------------(rifle]_ ... -�---- ---------------- [Plot plan, showing size of lot, location of system in ation fo wells, buildi s, etc., can be pl ed on reverse side]. „a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____ -�-:- = `i _=0�-------------- DATE - y------ -----------=---------- - i REVIEWEDBY------------------------ -------- --------- ------ ;�-------------------------;---- DATE-------- ----------------- BUILDING PERMIT ISSUED-------:------ --- I DATE - - - ------------------------•----------- Alterationsand/or recommendations------------------------------------- ------•-•--------•---------------------------------------------•--•--•---------------------•----•-------------------- -- -- •-------- --- --------•------------•----------------------•--------•---------------------•------------- •- ------------------------------------ ---------------------------------•----------------•----------------�' ----------•--------------------------•------------------------------------------------------------------------ ----------------- ----- �------ ------------------------------------ ---------- -------------•----------•--••-------------•--•--••-•--------- FINAL INSPECTION BY---------------- -- - --------------- ------------ "--� Date--------�--=3-------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street I 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California I� Manteca, California Tracy, California r ;w E5-9-2M Revised W-2100 II.