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� ��-.��t.-•.• Wim'--``�•'t (3 . �� s � ` ,r, APPLICATION FOR SANITATION PERMIT Permit No. .- -T_6.__1�__ : ,a (Complete in Duplicate) S t Date Issued _. 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 v my Ordinance No. 549. OO [� - JOB ADDRESS AND LOCATION. ---S — ;q F Owner's Name Phone-------------------•---------•----- Address--------------------------------------•--------- .. 4 !.-..--------------••---•---------------------------------- Contractor's Name---------------------------------- .---.- Phone �"r la.Q{ Installation will serve: Residence I( Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other E]Number of living units: ___L._ Number of bedrooms - Number of baths .!._-.-. Lot size ------_-.-__-_.-_____-_-_ Water Supply: Public system_5?�,Community system ❑ Private ❑ Depth to Water Table -'/- Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA,Hardpan ❑ Previous Application Made: Yes ❑ No_t�__New Construction: Yes bj�,No ❑ l}I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p��u//blit sewer is available within 200 feet.) Septic Tank: Distance from nearest well-,fY_ _.__ Distance from foundation---/0_'�------Material___- .. --------- N8. _ _--. Nn. ofcornpartments---2.-- - - ---Size- Liqu� e th � ----------CaPauty-R®o- �- • Disposal Field: Distance from nearest we1l-X1jxA)-._.Distance from fo ndation_P 0- -_--------Distance to nearest lot line---- Number of lines---;rf.___-_-.-_. Length of each line_c;2_6--------- ----------Width of trench-._-�_`�"--.--------_.---_Y Type os filter material__I__?1--.rWs---- "Depth of maAer�al___� !'_._�-__Total length ___cV_0-------------------_____-- � f Seepage Pit: Distance to nearest well---tiL_T--------Distance,fro foundation-----�r�-�-_--.Distance to nearest lot EffNumber of pits._ -1---------------Lining material_C-!;n4 ---:_Size: Diameter-_- ............Depth---!ZX'---------------- Cesspool: Distance from nearest well-----------------Distance from foundation_ __._.__.-_-_._--.Lining material------ Size: Diameter------- ----------- ---------'--De th---------------------------------------------------Liquid Capacity gals i Privy: Distance from nearest well_______________________-------.---___.-_..._--._Distance from nearest building.-__._..-__--_.------.__--.-._________ ❑ Distance to nearest lot line---- ---=-------------------------------------- -----------------•-•------------------------------------------------------------------------ Remodeling and/or repairing (describe):--------- - --------- ---------------•---•--•-------------------------------------------------------------------------••--•------------ s� , --------------------------------------------------------•-•---------------------------------------------------------------------------------------------------------------------------------------------------------------- t a ------------------------------------ -- -•--- -••--------•---------------------------------------------------------- ----------------------•-------------------------------------- ------_-------------------- I hereb!jfafe if y that I have prepared this application and that the work will be done in accordance with Sari Joaquin County ordinances, laws, and les and regulations of the San Joaquin Local Health District. ` (Signed)--------F- + A- Il-c.1---------- --------------------- ------------------------------------------(� Contractor) By:------------------------------------------------------------ - - -- - l - - - (Title].. �um --------------------------------- (Plot pian, showing size of lot, location of sys in relation to IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-- ----------------=-----------------------I=-- ----------------------------------------------- DATE- -------------------------------------------------- REVIEWED BY------------------------------- ------- --------------------------------------------------------- DATE--- - ------------------------------------------------- PERMITISSUED------------------------------------------------------------------------------------------------------ DATE--------Q --------------------------------- Alterationsand/or recommendations:---------- ------------------------------------ ---------------•--------------------------------------------•-•-----------•--------•--------------------------- rs ----------•----------------------------------------------------- --------- ------------------------------------------------------------•--------------------------- ------------------------------------------------------- -----•... •------------•-----------•-----------•---------------- ------------- --------------------------------------------I----------- ----------- -------- ------------------------------------ ---------------- k -------------------------------------------------------------------- - ----- ----- ------------------------------------------------------------------------------ ------ ------------------------------------- FINAL INSPECTION BY------------- Date - ---- - J----------- --------------------- 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 10-52 Revised W-2100