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� ( APPLICATION FOR SANITATION PERMIT Permit No. . 4__ (�.- . (Complete in Duplicate)�. 111 — _.bate Issued .__._ _3��. 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 AND LOCATION___ _______ T Owner's Name---------------- ---------E k_TrSR.e_CL�------------------------------------------ -------------- Phone_. ---------- Address----------------- __------Address-------------------------- v i Contractor's Name-------------1-112O-T0._--3 ------------------ --- ------------------------------------------- Phone--fes�-- Installation will serve: s Residence Q�Apartment House ❑ Commercial ❑, Trailer Court [] Motel ❑ Other ❑- Number of living units: l$umber of bedrooms _A,-- Number of baths size ------ --------------------- Water Supply: Public system -C- mm"unify system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3.'f t: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [rMar pan ❑ Previous Application Made: Yes E] No New Construction: Yes ❑ NoA/VA:,Yes ❑ No [1 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--------- -------- Distance from foundation--------------I----.Material---_______._---.-__-._.-_--...-_-_.-----..----. No. of compartments--------------------------Size------------------ --__. ----_Liquid de th------------- -Capacity I Disposal Field: Distance from nearest well. }- ..Distance'from foundation---_-J_b----__---.Distance to nearest lot [ ^: Number,of lines------------I-----------------------Length of eath.line----------------- Width of trench--- -- ----- --__ e, Type of filter mater;aI___:�!!_C__le- _ -----:Depth of filter material______ _______f______Total length----i'._------_-_--_-ab_--___-- Seepage„P•ri:. '. Distance to nearest well--- Arm --___Distance from foundation_�Q_-.-_-.--_.Distance to nearest lot line_s�----.,_-. � -------- Number r�-�_..Depth_ . , s�' Cesspool: Distance from newest well-----------------Linin mDistance from �ndafi anpiameter-_--Linin material 11�� { umber of rts-____- g .- Size: Diameter----- ----------------- -------------De th--------------------------- -- -Li Liquid-Ca acit - ❑ P - - ---------------- q P Y---------;-----------------gals. Privy: Distance from nearest well___. _„.7---------------------------------------Distance from nearesf building_.__------------------------------------------- .;. Distance to nearest of line : ,-,-' ----------------------------------------------------------------------•---•-----------------------'---•- - --•----------------------- r9 Remodeling and/or repairing (desoribe):--------------4 A -- -------•----------•---•----------------- !� -------------------------••---------------------------------------------------•----------------------•-------------------------------------------------------------- ------•---------------------•---:----- ------------------------------------------I-----------------------------•---------•-••-------------------------------------. -------------------- ------------------------------------------------ -------------------- ----------------------------------•-------------- , •- --------------------------------•---•------------------------------------------------------- ---•------- -----•--'i----------------------------- I hereby certify that I have prepared this application and-that the work will be done in accordance with'San Joaquin County t ordinances, State laws d rules and regulations of the San,Joaquin Local Health District. •�' I (Si Tiedl g �---------------- --- 3_,f��------ -------�- - - - - --- ---- ------- --- -- -- ---`------ �---------------------Owner and/or Contractor) gY� '� _fir -�- - --- - ---------1 . ----------------------- ,� (Title)-- �`- � (Plot plan, showing sizot, to tion of system in relation to wells s, etc., can be placed on reverse side). U, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - ------ ------------ --------------------------------------------------- DATE----------------- --------- REVIEWED BY------------------------------------- - DATE-------------- --------------------- BUILDING PERMIT ISSUED------------------------ --- DATE-----------------------•--- --------------------------------- Alterations and/or recommendations----- ------ -------------------------------------------------------------------------------•--•----,... ...._.. --------..---------•------------------- ------------------ ---------------------------------------------------------------------------------------------------------------------------------------------•---------------------------••------------------------ ------ �/VVB7/d� FINALINSPECTION BY----------- ---------•----------------------------------------- Date----...------------- �----• -'-----------------------------------------=- 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, Galiforma Tracy, California i. ES-9-2M . Revised 1-57 F.P.CO.