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APPLICATION FOR SANITATION PERMIT 4 ' (Complete in Duplicate) �• f Date Issued -,-,�'-_�� '-_ 5 i Application is hereby mads 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 O inance No. 549, JOB ADDRESS AND LOCATION-------------Ca_Q------. - ""' n -------------------- --•--------------------------••-------------- Owner's Name----------------- C__ - ► .� J r -� ---------------------------------------------------- Phone----Nor_-;$'----------------- Address-------------------•---- �lo-p Cr` ' Contractor's Name--------------------•------ � r �' e =��'�f ------- Phone--.--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.❑ r Number of living units: _ -_-- Number of bedrooms ._4-__ Number of baths _1__. Lot size -___c D_- --_c�_•f --— Supply: Public systemX Community system ❑ Private [] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ Previous Application Made: .,Yes ❑ No X New Construction: Yes,( No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s war is available within 200 feet.] 1 Septic Tank: Distance from nearest well +"� Distance from found tion_+_--------_--.Mat erial_ -- - - /Z"1,1< No. of compartments----- ------------___Size ( --- iquid depth_- i�----------Capacity g°` Distanc fromm istance from Disposal 'Field:. Number of lines ear�st ;eli_�eYt�,„_--__Length of each line----�n��_�_'----___-WidthDistance ofttrencnearest lot line--,5'- r e__�_ -- Type of filter matenale11 -------Depth of filter material-__IB_�----------Total length---M10 -•"__-•_ Seepage Pit: Distance to nearest well----------------------- from foundation__---_--__________.Distance to nearest lot line-.-_.__----._:-._ ] ❑ Number"of pits----------------------Lining material----------------------- Diameter----------------------- Depth -- pCesspool: Distance from nearest well-----------------Distance from foundation---------------- lining material------------------------ -------------- ❑ 'Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------- ------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building___--_--__--------__-_-----_______ Distance to nearest lot line- Remodeling and/or repairing (describe):------------------------------------------------------- ------------------•-•-----•-------------_---- ----------------------------------------------------------------- ----••-- --•----------------- ---------------------••-------------------------------- --------- --------------------•-------------- - -----------•--•------------ -----------------------------------------------------------------------------------------------------------•-------------------------- I hereby certify thatp have prepared this plication and that the work will be done in accordance with San Joaquin County ordinances, St . la , and rules and regulations lof the San 9baquin Local Health District. L- (Signed), - ------------- Contract B :--------_ � G6 _s-^-- C - !I ' ` or] y' w- , S � (Title] t-_jrr�--------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ ________ _ __ DATE-------- _ -- ------------------ ----- ---------------------------------REVIEWED BY------------- - ----- ------ "''"" Il; ; BUILDING PERMIT ISSUED ---------------------- DATE----------------- DATE-------------= ----- - d - ------------------------------------------------------------ Alterations and/or recommendations:------- ---------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------- --------------------------------------------- -------------------------------- ----------------------------------------------------------- ----------------- - ----------------------------------------------------------------------------=------ --------------------------------------------------------------- --------------------- PINAL INSPECTION BY------ ------ -------- ------------------- -------- ----------- - ------------------------ -------------------- ---------------------------------------------- .� --------- --------•- - ---�.--- ------- Date--- r SAN JOAQUIN LOCAL HEALTH DISTRICT 3 130 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 8-51 Revised W-2100