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r. �r A • *,w APPLICATION FOR SANITATION PERMIT Permit No. __ -tea-_ (Complete in Duplicate) `j-�- Date Issued _______________�2- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describid. This application is made in compliance with County Ordinance No. 549. o JOB ADDRESS AND LOCATION ��Yyo �Q� � "' 60 c `' - - ir",---------------------------------------------------------------------------- Owner's Name----------------------------------------ei__0 ----- ------ -- -- ' ' --------------- Phone__t2= ------- Address----------------•----------------------------------— -* ------------•----' - ---------------- ,p Contractors Name------------------------------ - ��"' �^ --- -----------------------------•-----.----- Phone_./__`�_ 46 d 4` Installation will serve: Residence Ij Apartment House ❑ Commercial)< Traile Cou ❑ Motel ❑ Other ❑ Number of living units: '_ Number of bedrooms ________ Number of baths :___ Lot size - '1.2-a _____ ��_"�--_-_--___ Water Supply: Public system ❑ Community system ❑ Private .K Depth to Water Table f'4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-❑P' 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.) • tic Tank: Distance nearest well-__.___y_______ _Danee from foundation Material-__----_ i Noof compartments - ZeLiquid depth_- Capacity_____________________ D- f I osal Fiend: Distance from nearest well__________ ______Distance from foundation______:_-_----.---_Distance to nearest lot line----__------_--_- Number. of lines-----------------------------------Length of each line-----------------------------.Width of trench-----------------.--_-------- w II___ __�__�_____Di tante oundation__..�-Z.4to nearest lot line_./__ ` Type of filter material-------------------------Depth of filter material________________ g _-_--_______________-_-_- _ _______Total length _ Seepage Pit: Distance to nearest e ,�.. s [ Number of pits--V---------------Lining material_ ' Size: Diameter.__*___.__Depth_- ... ____________ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-_-_-_-_---------------------__----_. ` ❑ Size: Diameter ; -----------Depth----•------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well----------------------------------- Distance from nearest'buildin -` ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------- 1 Remodeling and/or repairing (describe)----------------- ------------------------ ----------- --------------......------------------.............•-------------------------------------- ----------------------------------------------------- ----------------------------- ------- = � ,..-. �� :: -------------------------------.-----:-:------------------------•-----•- s . .- - - ---- -- -- ------- v c� E s ! hereby certify that I have p epare thi p�plsc tion and at to work will be done in accordance with San Joaquin County Y �# ordinances, State laws, and¢ ules and � lai�iQ lirh� au e M I{ ealth District. t {Signed}.... - . 1Q. ----- ---� � �-�; .- • - ._ ' ---------- ��eCt------------------------------- -� Contractor on ------------•---- ------- -- _ tr�._}��------------------ --------------•----Title -- ;---------= '�`- (Plot plan, showinb size of lot, Iota n ofesystem in relation to wells, buildings, etc., can be placed on reverse side). G l FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY------------------------------------------ DATE -�--1 REVIEWEDBY------------------------------`- ------ -' --------------------------------------------------------------------------- DATE-------- ------- f BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--'------------------- ------ ---- ----------------- , Alterations and/or recommendations------------------- ---------- -------------------------------------------------------------------•--•-----••-----------------------------------••--•-------- 1 4 ' ------ --------------------------------------.-------------------------------------------------------------------------------------------------------------------------------------.----------------------------------------------- ----------------------------------------------------------------------------------------------------- .___ ---------------;--------------------------------------------------------------------------------------------------.---------------_---._.----... _-----_---_--_-__--_ I FINAL INSPECTIONti ----------- ---------------------------------` -- `-- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+ree+ 132 Sycamore Street 814 Nor+h "C" Street + Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100