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APPLICATION FOR SANITATION PERMIT Permit,No. ___ -------- (Complete in Duplicate) Date Issued F Appli e66n=-i-s'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. :. f JOBADDRESS AND LOCATION..}_ -p G�-----S._-. - ------ ---- ----------------------------------------------=------------------------------------- : W - ----- -- ----_----------------------------- Phone �x Owner] Name "--. ----- +r f s F S + '' " Address �• .;a ------•- -- ---- Contractor's Na e----------- ---------------------------------------------� - ------------------ "----------------------- ----- Phone Installation will serve: 'EResidence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Othe r,,❑ Number of living units: A_- Number of bedrooms .__ _ Number of baths ___f"__ Lot lsizeI_L-lL"_X----.L5_jO--------------------------- Water'Supply: Public system ❑ Community'system ❑"` Private ©"""Depth-to'Water Table'./Pl ft. Character of soil to a depth of 3 feet: Sand E]T Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑, Adobe ka/ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No R�/ TYPE OF INSTALLATION--'AND-SPECIFICATIONS: � No tank�or"cess'ool ermined if uhlic 'ver is-availa6le_w.ithin_200 feet} Septic Tank: Distance from nearesr well.''i *_Distance from found atior+F- x ;..i_�vlateriai__----------------------------------------------- L __ ____________ : K '" size Liquid depth Capacity No. of compartments_ � � 1e - t q ,,. �.--�.: 11.E Disposal Field: Distance from nea st well_.._" � �,..Distance from foundation - :---Distance to-nearest lot ine._ r ❑ Number of line`sC " '" f 1. . Length of each line------------------ Y ----..Width of trench -�}.. � ,-------------1 . Type of filter'material r, ,E� °�_Depth of filter materia --_,___._Total length------ _ r'�_,.-.---_________--_ V.., - f v Seepage Pit: Distance to nearest"well_._-_S_Q_ i�`i____D�stance from foundation_.I_,Y.ter ___..Dista ce to nearest lot lin -�_�- `r Number. of pits---- ----------- Lining mater iai_.2.Rd_U1�.Size:'Diam . ----a.-- c-----Deptn----�a--- - -,---- --A,------ f 1 s s'+ [ Cesspool: ;Qisfance froin�nearest�wel! .. ,Y:_-Distance from fo�ndat on +, x---,Loring materia! " -gals.Depth: N - -- _-Liquid Capacity ;❑ - __. -from nearest building.-- ❑.'" Y '- .. , { - -- ^ p ,istance PrivY Distance from rearest wel._ -> -- ---------------------D Distance'to nearest lot - ------------ -------------------- ----u---- .-.----- - ---- ------ Remodelin and/orrepairmg (describe):__.. JAL-11. = -I � ica --------------•------------------- "4---------- ---•---- •------------- �------------------------------ --------- --------- 4"------ ------------------------------------------ - -- - - _ q y I hereby certify that I have prepared this application and that the work will`be done in accordance-with San Joaquin Count ordinances, State-laws, and rules and regulations of the San Joaquin Local Health District. (Signed) /�.�-(y7�l�L --:- LCtiPt =----------------------(Owner and/or Contractor} Y_ #_lot �Eocation..of_s stem�.in.�.relation::to we1ls,,buildings,_etc., 'Can be ____"______________".___--_____------------------------------ ""---------- -------- "--- - B - ----- ------ - ------------ - -- --- ( er-- - - :� - I (Plot-plan showing-size-a placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION REVIEWED BY. ACCEPTED BY _--------- --- DATE---------------- - --- -- ------- DATE ------------ BUILDING PERMIT ISSUED----------------- ------ -------- _ DATE------ ----------------- ----------- - , -" - -- Alterations and/or re�co.mme^n^d.-a_tions----------------'-----t---"- ---- - -----_-------------C-�--------- ----------------------------------------- ---I-••---_-•----••---------------------------------------- -- -------- __._ . ____ --------------------------- "__ _____________________ _-__ -- _- _ - __ _ I . --------------- _ ----- - -- - -- .- - --- -._-_._-_----_-_-•-___. "--- -- -------- --------------------"' - -----•___._____ ----------------- - -------•-- ---------------- -- --- --- - r 5 - = FINAL- INSPECTION --- Date---------� -- -�---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North '•C'• Street Stockton, California Lodi, California Manteca, California Tracy, California I B-9-2M Revised W-2100