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7 No. APPLICATION FOR SANITATION PERMIT Permit ----x.______ 4 (Complete in Duplicate) Date Issued ") _�,�/S.__.� Application is here y made to the Son Joaquin Local Health District for a permit to constru nd 'install the work herein described. .' This application is made in compliance with Co ty Ordinance 01)10, JOB ADDRESS ANDZAj ?11 �. --- ------ ----- ------------------------------- ---- --------------- Owner's Name------------- - - JI- --------------- -------- -------- ------------------------ ---------------- Phone,5=1('W'94 ------------------- -------------- -------------------------------------- Address-------------_._......... - --------- ------ Contractor's Name- --- ----- —7-Me-1------------------------------------------------------------- Phone__7=,47007--------- f Installation will serve: Residence Apartment House E] Commercial C] Trailer Court [] Motel E] Other E] Number of living units'.' -I--- Number of bedrooms --Z'- Number of baths __A�Lot size ______________________ Wa+er Supply: Public syste'il E] Community system ❑ Private Depth to Water Table.50 ft. M Character of soil to a.depth io f 3 feet: Sand E] Gravel F] Sandy Loam.E] Clay Loam E] Clay F] Adobe x Hardpan ❑ Previous Application Made 'lyes ] No VE New Construction: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-----------------:-------I----------------------- ❑ No. of compartments---------------- ----Size-------------------------------Liquid clepth--------------------------Capacity------------------------N1.1 Disposal Field: Distance;from nearest well--- - -'r------Distance from foundation_ Z-161---_.__.Distance to nearest lot line---4......... Numberil I*ines__C_>-L�__ Length of each line---ji�v ------- ------- Width of ---------------Nzj 0 rf ... .. Type of filter materiall Depth of filter material----/Iff_ . ... Total length____________________ -_0_.__- ______. [ Seepage 0-------- Seepage Pit: Distance!�o nearest well----------------------Distance from foundation___________________Distance to nearest lot line_.___.._---_.-._ El Number' f pits----------------------Lining mafe,ial-----------------------Size: Diameter--- ---------- --------Depth------ -------1------------------ Cesspool: Distance.1 from nearest well-----------------Distance from foundation--------------------Lining material__..__--___-_-------___:_---__.__--__. ❑ Size: Didreter----------------------------- -- ----Depth----------------------------------------------------Liquid Capacity....-------------- ---------gals. : 1 Privy: Disfanceifrom nearest well----____----.----- -----------___. -------------Disfance from nearest 6uilcling ---- - ----------------------------- F1Disfancelio nearest lot line--------------------------------- -------------- -----------------------I----------------------------------------------- ---------------------- Remodeling and/or repairing (describe :----- ----- -- - - :'t ---------- ----- ----------- IP ----- --------�!----- ---------- ------ ----- -, -------------------------------------------------------------- ------------ -- ------------ ----------------------------------------------- - ------------------------------------------------------------------------- ----------- ---------------------- ------------------------------------------------- -- --------------- ----------------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify Ffhave prepared this application and that the work will be done in accordance with San Joaquin County a ordinances, State laws, and)uIes and regula is of the San Joaquin Local Health District. . I iji ------- - ------- - Owner Co fir, ------- -------- - --- --------- ------------- (Owneran,*/'Zr Co tracfor) (Signed)------------------------ 41,r_ --- - --- -------------- ----- -- rse --------------- By:------------------- -- --------------- ---------- -------------- --------(Title)----- ------ - ------- --------- L ------- (Plot plan, showing size Aof.'liocation off system in relation to Is, buildings, etc., can be pla pla e on reverse side). I91Rj?��ATM ENT USE ONLY " APPLICATION ACCEPTED BY-------- •------- DATE ------------------ REVIEWEDBY--------------------- - -----------------------•------ ---------------------------------------------- DATE---------Z---------f:•------------------------------------- ' BUILDINGPERMIT ISSUED AT---------------------_-------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommenill c atiions------------------------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------••---------------------I----------------------- -------------------------------------------------------------- ------------------------------------------------1111------------------- I---------------------------------------------I----------------- ------------------------------------------------•--- ------------- - -------------- Il ----------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------ ------------- ---------------- ---------------------------------------------------------------------------------------------- ----------- _/—-- ------------------------------------------ FINAL INSPECTION BY:!..---------f� / ---------------------- Date-.-------------- --- ------ 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 ES-9-2M 10-52 Revised W-2100 40