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k APPLICATION FOR SANITATION PERM11 IT \ Permit (Complete in Duplicate) � •. Date Issued„__--- -5'-'-__---- -- •, Applicaion is hereby made to the San Joaquin Local Health District for a permit to con,�truct andinstallherein scd . This application is made.in compliance with County Ordinance No. 549. 0"'t /,4, .ef awl' JOBcADDRESS AND LOCA ION_ [AAA.... ax.. � ` � �C1 2--- /= -C�a"� 'I------------- Owner's Name--------- %AM �_lQ/-�`------. 1- !n -------- Phone._ Q - - ---- --- Address..... - � ----��----� ----- - - ---- ------ ----- �- - Contractor's Name------------------------------ -�- ' - -------------- P oRe �=F Installation will serve: Resiclencvv� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_ Number of bedrooms J� Number of baths ___1--- Lot size ___--_ _ _-:-_.-_-_-__-_:_---_--___-_ Water Supply: Public system [I Community system El Private E] Depth to Water Tableft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ Cla am ❑ Clay ❑ Adobew Hardpan ❑ ' Previous Application Made: Yes ❑ Nox New Construction: Yes ❑ No ❑ 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_�iD._i--_---Distance from foun ation--.I-------------Material------ -_________..._.._.._._.__ ------ --- --- �`��C- �iquid depth C?��----- No. of compartments-__ _ Size_ � � _Capacity_�4IO_ _�1 Disposal Field: Distance from nearest well-70 Distance from toundation__,f-d_'-------Distance to nearest lot line---- f Number or lines---_4_____-__j____��__.______-Length of each --------------Width of trench_.�.�_"_.I--___-___... Type of filter material-_r�y__ ___Depth of filter material....I� _------Total length---------_ ---_____________ Seepa a Pit: Distance to near st well-1-00" Distance fr �fo ndation__f�._____.Distance to nearest I line__-_- Number of pits--------------------Lining material ___Size: Diameter( _. _��_...___Depth____- -_----_-_---_ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--.:_:.-_----__----------_-_-_------. ❑ Size: Diameter------------- ------------------------:Depth-- -------------------------------.-- ----- ------Liquid..Capacity--- gals. 1' Privy: Distance from rsearest well__- ---------------------------"__,___.-_...__-__Distance from nearest building----------_---.--__---_-_--._________.___. ❑ Distance to nearest lot line--------------------------------------------- - ---------------r--------------------------------------------------------------------------- Remodeling and/or repairing (describe):--- --6�_P4y_--v ---- - t` ---------------------- ----------------------•------- --- ------------------------ ----------------------------------------------- /� �------ R� =_. fir- fc_ __._ _ c------------------------------------------------- ----------- Vcerfify ------------------ ------------------------------------------•-•------------------------------------.------------------------------------------------------ I herI have prep his plication and that the work willbe done in accordance with San Joaquin County ordinanced rules a d regul tions of the San Joaquin Local Health District. -�"--"------ ----- ----- ------------ ------- Contractor(Signed) 1- �'� ) By:---------------------- --------------------------------------------------- - --- --`---- ------ ---------------(Title)_�.�-o�1- - a- �----------------- (Plot plan, showing size of lot, location of system in relat to wells, buildin etc., can be placed on reverse side). FOR APARTMENT USE ONLY r APPLICATIOWACCEPTED BY DATE ---------------------------------------------- REVIEWED BY------------- --------------- 1 DATE BUILDING PERMIT ISSUED ZJ - DATE---------:- ---------------------------------------•------ `. Alterationsand/or recommendations------------------------------- ---------- -----------------•---------------------------------------------- --------------------------------•------------------- - ------------------------------------------------------------------ ---------------------------------------------------------------------•--- ----------------------------------------------------------------------------- --------- -----------------------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------------------. -----------------------------------------------------------------------------•----------- --------------- ------------------------------------- ------- --------------------- ------------------------- --------------------- FINAL INSPECTION BY:----------- ��--------- Data ------ ----------------------------------- 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 ; Revised W-2100