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__� ::O .� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 /I fl (j Date issued __ __'k_- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dss / ed. This application is made in compliance with County Ordinance No. 4�9. . � f JOB ADDRESS AND LOCATION--------- , ' - = -----__-- - - - Owner's Name =� fr'J f � __�_ '= "�'f`'L__-- .. Phone Address C! >a_' -rc-f' �lr' _ ^------------------- Contractor's Name----------p- -- ----- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel,E. Ofhher. ❑� { /' e,Number of living units: _ Number of bedrooms-3- Number ofba�ths _�__ Lot'size ____6__r�_ Water Supply: Public system ❑ Community system F Private Depth to Water Table _- s Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam ❑Clay Loam ❑ Clay ❑ Adobe Vj'`Hardpan ❑ Previous Application Made: Yes Ll No 5d__-New Construction: Yes ©�o ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E Septic Ta k-! Distance from nearest weIIL __ _.__Distance f Tm fouhdation_-_6 ~__.Mateo '_______ ---�4___ No. of compartmen s__. ,_, Li uid depth _____ ______ =_ Size____.:-% i-- q p Capacity__- _ ___-- Disposal F' 1N: Distance from near gs well___------G__.._.Di stance, from foundation___rf. 3`_____Distance to nearest lotline__�_�____- Number of lines_ _ ______Length of each line_,_.-t__69__e___`.;�----Width of trench__ _ __ ----------_---- --------------------------- Type of filter material �s_c------Depth of,.filter material---l�_----------Total length_____,�____`_ ___________________ Seepage Pit: Distance to nearest well________________ _ Dis arise from;.,foundation------------_-------Distance to nearest lot line----------------- "% ❑ Number of 'pits----------------------Lining m -___ aterial- '---- __ - :-_------Size: Diameter------------- V Cesspool: Distance from nearest well____________ Distance from foundation_------- ---_--Lining material------------- __-_-_._.___.-. ❑ Size. Diameter--------------------------------------Depth __ ___ _____Liquid Capacity ____ gals. Privy: Qkstance from nearest well Q stance from nearest building-__-- ❑ Distance to nearest lot line, ----------------------------- ----- j'�-� Remodeling and/or repairing (describe): ____---------- ;� ____ _____ 'k :....--------------._.:;f -j _______ 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 regulations of the Sen Joaquin Local Health District. Si ned _�j b i .- - G1 /` ---r------------------------ ___10tirner and "r Contractor $ - I' .' t '- ---- -------------------------------------------------------- (Plot ---K�----------------------- Y� - --{Title) (Plot plan, showing size of lot, location of-system in relationjto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE _ REVIEWED BY--------------------------------------------------------------------------- - -------------------------------------- DATE--------Vyz ----------------------------------- BUILDINGPERMIT ISSUED-------------------------------------:'------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations----------------------------------------------------------------------------------------------------•------------------------•--------- -------------------------------------------------------•--------------------- ------------------------------------------------------------------•----------- ------------- -------- ---------------------------------------------------------•---------------------------------------------------------------------------------------- -- --- ----- ---------------------------------------------- FINAL INSPECTION BY:---- ---1-1--- �------------------------------- 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 6-51: Revised W-2100 _. -