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APPLICATION FOR SANITATION PERMIT Permit No. .. -. - Y� (Complete in Duplicate) l f' hate Issued A plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d s ribed. This application is made in compliance with County Ordinance No. 54 t JOB ADDRESS AND L—O—C�ATk N-----Ed ------L---l�---"---•----------- 1--t ---------------------------- Owner's Name C� ------- Phone do l Address------•---------•--- ------------------------------------_--•- ----------------.-. ......-----------------------------------------�7------- ` t�L�_f (�•� Phone , Contractor's Name------------------------------------ -=------ -------•-•--------------•-------------•- Installation will serve: Reside��-KNumber ceApartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ - 1V----------------------------- Number of living units: of bedrooms �___ Number of ba#hs .Y- Lot size ___�:----- -�--- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table _yZft. Character of soil to a depth of 3 feet:" Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ f Previous Application Made: Yes ❑ No 9 0 1 New Construction: Yes E] No 1-6.9a- TYPE TYPE OF INSTALLATION AND SPECIFICATIONS: .. l (No septic tank or cesspool pe�miiFted if public sewer is available within 240 feet.) 11 ..._.,�. ,..,, . w — . ,. _ . .. ---&,� a&2it---------- Septic Tank: Distance from nearest well_ � _Distance from foundation__ No. of compartments-;_—, -Siz � -- @_tlrLi uid cle }h-_-- 2------------Capacitylaz4� -` Disposal Field: Distance from nearest well_/ (/ Distance from foundation__'___._______.Distance to nearest lot line--- Disposalrvf of lines___.-- ------ Length of each hne___�_�� << Width of trench ---------------------- --------- _____________________ Type of filter material_- �� -----Depth of filter material___.- _-______ -Total length______ ------------------------- Seepa a Pit: Distance to nearest well__ _ Distance from foundation_-:__...........Distance to nearest lot line_.--___.__ rr Number of pits_-OXIA ---___Lining material- _�_L°4[ i..Size: Diameter--- 8------------Dept'n_" -�-� Cesspool: Distance from nearest well------------------Distance from foundation...._._--------___-Lining material-_.________-_______._____---/---______. Size: Diameter-- ------.Depth-------------------------------------- Liquid Capacity gals. Privy- Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------:-------------- - Distance to nearest lot line- --- --------------------------- ---- ---------------- -----------"------- ---------- Remodeling and/or repairing (describe)_______ ___________ --- --------------J � -------- ._..... ---------------- ---- ---------Z--- — _ ---------------•--------------------- - ` = " ----- --- - -- ----------------------------------------------- ------------- I hereby certify that ave p pared this appl' ation and that the work will be done in'accordance with San Joaquin County ordinances, State laws, a d rules nd regulations f�the am Joa ufn cal Health District. f j /f ------------------ ----- --------- Owner an r Contractor) (Signed) /1�- {T � 1� (Plot plan, showing size of t, location of system in relation to wells, bur dings, etc., can be placed n reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- --------------------------- DATE----------- ; 2: -----•----------- REVIEWED BY------------------------------------------------- ------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------- ---------•------------------------------- DATE_-------------•------------------------------------------- Alterations and/or recommendations:----------------------- --------------•----------------------------•----••----------•--• •------------------------- > ------------•--- -----•--------------------------------------------------------------------------------- ---- ---------------------- ----------------- ------------ FINAL INSPECTION BY---------------4,11-1) --- --------4,11-1)---4 - ---------------------- ,Date--------------•--- -- -- ----- -- --- ------ ---------------------------- I 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 E5-9-2M 0-52 Revised W-2100