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ev� ✓ APPLICATION FOR SANITATION PERMIT Permit No. ____ __��4 a__--- (Complete in Duplicate) Date issued L --- -` -- Application 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 Ordinance No. 549. i. JOB ADDRESS AND LOCATION__-'71_.3_v7_C&Q eko1j-1 -S_....-- GI___a------------------- - Owner's Name_______________ r F► _ _Fd CA+t sof '.... . 'Jtl�Phone-----�_:- ,?` I Address -------------------------------- 6-:rzgf '1t -----------------•-•------------------------------------------------------------------------ { Contractor's Name---------------------------------- � i ---------- -Az_c-------- -----------------------•-------------------- Phone----- 9 d-------- Installation will serve: Residence 19 Apartment House E] Commercial E] Trailer Court ElMotel E] Other.E]Number of living units: ---/__ Number of bedrooms -V_ Number of baths I..... Lot size ---y�4nf?.9------------ __________________ Water Supply: Public system ❑ Community system ❑ Private ;g Deoth to Water Table,.,bft. Character of soil to-a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No)9— New Construction: YesX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted .if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest wej___(�_� _.____Distance from found tion__ P� �/ j-0-----------.Material__-��-----------•- No. of compartments___________ _____________Size__7-— �tiquid depth__-S� ��.-_-._._-Capacity__"-Capacity--"- Disposal Field: Distance from nearest well-_ d_. _..._Distance fromoundation-----�_ __.....Distance to nearest lot line_________-- Number of lines....I-----------. ---Length of each line___.'$./-- _ _------Width of trench.--. ! -------- -------- Type of filter material__-1 YV ,--Depth of filter material------ ___------__Total length--__________.____---4.0___------ Seepage Pit: Distance to nearest well__-_-_.1QQ__---Distance fr m fundation_--,1_ - Distance to nearest lot li �_.._04r.10 Number of pits-----,----_. g ---Size: Diameter_.. �� p ' � - -------Linin material- - - Diameter_.143 ---De to--- - - ------------ Cesspool: ------------- Cesspool: 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--,-------------------------------------------- ------------------- r.y Remodeling and/or repairing {describe):------------------------------------------------------------------------------------------------------------------------------------ ------------------- ----------•------•-----•----------------------------------•----•---------------------------•-------------------------------------------------------------------------- --------------------------------------------------- ---------------I-------------------------------------------------•------------------•-------•-------------------------------•-------------------------------------------------------------------------------------=---------- ------------------------------------------------------------------ ---- -------------------------------------------------------------------------------------------------------•---------------------------------------- -_ I hereby certify that I have prep red is application and t t the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an ations of he San Jo uin Local Health District. (Signed)-- --- --------------------- --!�- -- -- ---- -------it—,mc ------------------------------------ -------( caner an or ontractor) B � 7 =---------------------------------•-------------- ------------------ ----ITitle)------ _I! 3`3-------------- y , (Plot plan, wing size of t, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-< ------ — DATE-_'t ------------------------------- REVIEWEDBY------------------ -------------- -------_------------------------------------------------------------- ---------- DATE---- - BUILDING PERMIT ISSUED------------- ---------------------•-•----------------------- ------------------- DATE--------- Alterations and/or recommendations:-------------------------------------------------------------------------------------- ---•----•---------------------•-----•-•---------------------------- ------------------------------------------------------•------------------ -------------------= ---------------------------------------------------- ------------------------------•--•---------------------------------------- -- - - _ ------------------------------------- ------------------------------ ---------------- ------ --- -------------------------- ----------------------- --------- ---------------- -------------------------- ------------- FINAL INSPECTION• BY:-------04el --------- ----- • - -- ---------- 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 E5-9-2M 10-52 Revised W-2100