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APPLICATION FOR SANITATION PERMIT Permit No. .3_3.T-j�' (Complete in Duplicate) Date Issued 12712._�Ox 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 with County Ordinance,No. 549, JOB ADDRESS AMID LOCATION.__ I __ -+ _)4 _ ________ '' t ------------------- ----------- ------- -- - Owner's Name - s - - ----(Phone---------- ------------------------------------ Address... a_-ur ' -------- -------------------------------- l _.fes-- ---------------------------------------------------------------------------------- Contractor's Name--------- =` = -------------------f ------------------------------------- Phone-------------------------------- Installation will serve`ZResidence;;X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [J Other ❑ Number of living units: __ _ Number of bedrooms --- - Number of baths - -- Lot size ____�'Sr__. c.� ►' ------------------- Water Supply: Public system ❑ Community system ❑ Private � Depth to Wafer Table -------- ft. I Character of soil to a depth of 3 feet: Sand 11 ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No to New Construction: Yes No ❑ + Y/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: • Distance from nearest well___4_.0___Distance from fouridafion---/0---------Materi I____ ________ _______ �_----__--. No. of compartments - Size_- �/ ? J p ---- - ,� - �'-*--�--�-~-------------Liquid depth------ ------------CapacitY-----�-�-�----- -`-`�'� Disposal Field: Distance from nearest fwell______!_Q_-.--Distance from foundation-- LZ-_--_-Distance to nearest lot li e__--. - m Number of lines-----------I-_-----_ _ __ Length of each line___-- .: . Q-------.Width of french_--_c _Q____ ,_-_-_ ; Type of filter material___.9 __ epth of filter material__- _ !_� .---Total length______ ___ _<� -_ Seepage Pit: Distance to nearest well------_--------_ ---Distance from foundation-------------------Distance to nearest lot line----_---_ k ❑ Number of pits----------------------Lining material-------•---------------Size: Diameter-----------------------Depth---------------------------- I Cesspool: Distance from nearest well-----------------Distance from foundation_---_--------------Lining material_----_-__------_-____--_---__-_--_--. ❑ Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals Cn Privy: Distance from nearest well----------------------------------------------_-Distance from nearest building-___-_--_____--_----_-____--___--___. ❑ Distance to nearest lot l�in'e?-,------------------------------�---�---------/---.-.-.------------------:-�------------------------------------------------,- . Remodeling and/or repairing -= - --- ----- - . --- ----- --- �----------------------- - �----- - �` -� •�ti {ejf'certiy°t�a'F`I�Ita., repa�+his p Ica fi aid ThatFfe diark will !ae done in accordance with Sart Joaquin County ordinances, State laws, and rules and regulations of IT' San Joaquin Local Health District. �fir' 'r'��-/ �'/� �•-�--f �•� -�'��ii - (Signed)--- = f'�t- ` _ - F-----------------------------------------------------------------------------------------------------•--- --- Owner and/or Contractor) BY:-----------------------------------------------------------t �------------------------------------------------------------(Ti+le) ..................... 4---------------------------------•------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ----_ t DATE REVIEWED BY-----------------------------------------------------I I A j DATE=n _ BUILDING PERMIT ISSUED-------------------------------�---«------ `� ►�.�' --- - - DATE----------- - -- -----------------------• Alterations and/or recommendations---------------- - --------------------------------------------------------- ------------- r ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- --------------- ----I------I-------------------------------------------------------------------------------------------- ------------------•--------------------------------------------------------'------------------------------------------------- ----- ---------------------------------------------------------•-- L ..7, FINAL INSPECTION BY-------------- -_., � �: ------- Date----.-----_�_.r� r .•�-� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1~S-9--2M 8-51 Revised W-2100