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r t APPLICATION FOR SANITATION PERMIT Permit No. -r__6. [Complete in Duplicated - s Date Issued `` _ A lication i 'Aby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Pp This application is made in compliance with Co ty Ordj a1r NZ)5 �,G� . d �d � C ��. JOB ADDRESS AND LOCATION---------I -------------------------------------------- ------------ Owner's Name---------------- -------- w -------------------- -- --- ------- y. Phone------------------------------------ Address.-....-•----------------'=-----•-/17.10.1-5-------- .... `----------------- ----•--------------••-----------�------------------•--- --------...----- Contractor's NameI-----------------------•-- . --------------------------------------------------•-------------------•--. Phone----------------------------------- e Installation will serve: Residence,,& Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo el F] Other E] Number of living units: -------- Number of bedrooms ____1_ Number of baths ---/--- Lot size __._-___ __. _-G -C--------------------- Water Supply: Public system ❑ Community system'❑—Private�.Depth to Water Table -------- ft. t Character of soil to depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,[No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Septic Tank: Distance from nearest well- -----Distance from foundation-----1_O-------.Material_________ _________________________________ No. of compartments _ -- -___ kwd P Sze---�x--- --� Liquid d 1pth CapacatY Dis Dial Field: Distance from nearest well--6-2)_._.._.Distance from gfoundation----�_0:--------Distance to nearest lot line____ ------- L -_�__. Number of lines_________._ -_______________Length,of eaclh'line_''_______—— -------.Width of trench_-______ "�.._______-_._ Type of -Filter material-�zr______-Depth of `filter mater�al--------/4-"f_.____Total length____ __________l-d_�J-__.__________� Seepage Pit: Distance to nearest well----------------------Distance from foundation____________________Distance to nearest lot line__._____.____--- ❑ Number of pits----------------------Lining material-------------------_.Size:. Diameter------------------------Depth--------- ------------------ ----- i # - Cesspool: Distance from nearest well-----------------Distance from foundation_______-______.__..Lining material-.__-__-_-_-_..__._.____.____.______- ❑ Size: Diameter--------------------------------------Depth---------------------�--fi t---------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well----------_--------------------------------------Disiance from nearest building---------------------------------- ..___--- ❑ Distance to nearest lot line-----------------------------------------------------J------------------------------------------------------------------- ------- Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- --•--------------•-----------------------------------------------------------------------------------------•------------------------------•--------------- ---------------------.------------------------------- # 4 F e` e - - - -= - -- --- ----•--------------------------------------------•-----• --•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in'accordance with San Joaquin County Qrdinances, State laws, and rules and regulations of the Sanq )Joa uin Local Health District. . t ► r (Signed) :^'`f { - ---- ------------------------------------------------ (Owner and/or Contractor Plot plan, showing size=------••----------------------------------------------------- -- - - - - - Title --- Y ---- -- - ----- - ----- -------------{ --------------------------------------------- ( p g of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r r V 1 FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY--------------- f DATE... :___.___ E REVIEWED BY---------------E------------ - DATE_ �J c �-•-------------------------------- - - --------- - ------------- BUILD NG PERMIT ISSUED ---------._ DATE-------- ------------------- ----- R 9 ___________ Alt tion"s and%or rec mendation :c:.__ _ -�� "`"` 4 �s 41 AL - __ ___ ... - - - ..N __ Ir A -------------- ________________ --._________.____ _ _ ___ .. _. - __ -_ __________ ___.....______.___-____.__-_______..-_.._..________.._. _____________________________ _._____--______-___.._.-____.____.__-- -_---.------------------------_------------------------------------------------------- ---------- /_ ----------------------------------- -------- FINAL INSPECTION BY------------------ - ------------------- 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 10-52 Revised W-2100