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APPLICATION FOR SANITATION PERMIT — Permit N&OF -_--.. (Complete in Duplicate) �'^ Date Issued - --------- ---- -77 ApplicaFion 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. 5 j CATION: _-JOB ADDRESS AND L :- .- _- ------------------------------------------------------------- Owner's Na e------ ." o.. -------- =-T ---- Phone- - -----•----------------- -_Address. �._ Contractor's Name- _ I t ------------------ - ------ Phone.��-0-�o --1'---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms - - Number of baths. /___ Lot size -- d _ GS S-��--------------------- Water Supply: Public system 2Community system ❑'"'Private•❑ Depth to Water Table-:50--ft. " Character of'soil to a depth of 3 feet:—Sand ❑-•'Gravel'❑'"'Sandy Loam ❑~Clay toa'M-0' Clay E] Adobe Hardpan L]Previous Application Made: Yes ❑l No �ew Constr6c«tion: Yes No [] : t I TYPE OF INSTALLATION AND SPECIFICATIONS: fir, I {No septic tank or cesspool permitted if public sewer is available within 200 feet.]! j?pfi Tank: Distance from nearesT well-----------------:DistanceVrom foundation__:-._----1-----.Material-'--- '--._-_--. �No: of compart ants- size= ----------- -� 1 q P. Capacity-----------•----------- ____Liquid de th__'-------___ ° ispos I field: Distance from nearest weN-------------- Distance from foundation-_1 - -:--:_:Distance to nearest lot line.__-__-------._- Number of lines--------------I--------------------Length of each li e------�-------------t--------Width of trench---------------------------------- 44-1 Type of filter material----I--------------------Depth of filter.material,___------.--- ----..Total. length-. ----_------__-- _----------`---___.-. r y� .7 Seepage Pi7 Distance to nearest well-'F� -'_`__Distance from foul dation------`- ��---Distance to nearest-lot line--Zd_--_- Number ofits-.-- -- i - r r p -------:.----Lining material- - c.,ae: Diameter Depth-------- ---------------- Cesspool: Distance from nearest well----_-_-=.�Distance-from-foundation-----------I-- -----Lining material-------------------.------ ❑ Size: Diameter= `----=------ '--------- `Depth_.--------- = ---_---------1- --Liquid Capacity---------------------------•gals. . _ Privy:4 Distance from nearest well----------------�----^�-------------'-Y- _.Distance from,.nearest building- - € :---t ----_-_ Distance-to.nearest lot:line-^'4-'_=='------- --------------------------------s....--.-......--- Remodeling and/or repairing,(descrabe):_-- - ------ -------- ---------------- -------------------------------�-----------°---------------- ! ; _:.: 9 - k-n r+I ------------------------- -•------------------ --------- --- ----------------------- r � ------_---------."�, :.. 3, ---------------- -------------------------------------------#----------------------'--------=------------------------ ---------...---------------------------------- ----------------------- ---- ---------------------- I hereby certify that I have.prepared this application and that the work will be-done in accordance-with San Joaquin County ordinances, State laws, and rules and regula+ions of the San Joaquin Local Health District. ------- k J_ i Oto r (Signed) an r on rac B t -- ------------- er o for x (Plot plan, showing size of lot, location`of gkem in relation to wells, buif8irigs, etc., can be placed on reverse side_]. FOR DEPARTMENT USE ONLY.., -• k { APPLICATION ACCEPTED BY ._-._i ------------------------------------------------------------` DA � - �.�- -- ----.. DATE�_r _ BUILDNG PERMIT ISSUED-----------------�----------------------- -- _-------------;-------------------------- DATE------------ Alterations and/or recommendat-ons------------------------------------``------- ---------------------------------------------`------------ ---•• = � .. a . - = --------;-•-----------------------------------••--• ---------- ------------------------- ------------------------------•--------- ----------- ---------------- ---------- ------ ---------------- ------------------. ------•-------------------------------------- t f _.-..---------------------'--.-- .-..----------.._---..--•--•--.._---.._-__-_'-- -.----------------------.-- -- ---- -- 5�y FINAL INSPECTION BY------------- " = - I 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-4-2M ; Revised W-2100