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-( , APPLICATION FOR SANITATION PERMIT Permit No.�. _-- ��"( �Pef (Complete in Duplicate) Date Issued...... .. �-y Applica+ion 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---- -71 -L... ....4.nodi-L-G------------------------------------------- ll-/�./V/Vef .1. `- --------------------------------------- Phone....4/10................. Name____.__..�_^_-._�__..__.. Address----------------r„�?. 2-- ----------------------------------------------------------------------------------- ----------- Contractor's Name---------------------------- f �.,� -- v`- PhonQ'fG= SP 7 r�-- Installation will serve: Residence 4 Apartment House ❑,, /Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: ._-___ Number of bedrooms .�'". Number of baths /----- Lot size ____________'____-___-• Water Supply: Public system ❑ Community system ❑ Private K Depth -to Water Table#.Sift. t A Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ X72` Previous Application Made: Yes ❑ NoA. New Construction: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: v (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanl KG Distance from nearest well-----------------Distance from foundation....................Material------------------------------------------------- ❑4415+`' No. of compartments---------- ---- ----Size--------------------------------Liquid depth---------- ---------------Capacity----------------------- Disposal Field: Distance. from nearest el _ �_ ._.Distance from foundation. M . _ ............Distance to nearest lot line---s ........ ' �+ w _ ,_�o . Number of Iines(7104.__y�,i _ - Length of each line__�J�__..�.t_ ----------Width of trencch-_-�4._._......_-________ Type of filter mate ria lj.t__�QCI�_-Depth of filter material..�Q._-.-.___-__Totallength._>-l�______________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation.....................Distance to nearest lot line__--___---_-____• ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material__--_-__--_.__--___--_______----__--_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well------------------_------------------------------Distance from nearest building_-______-__-___.-._---_---____-_---_---.-. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):. --- ------------ ----- ------------------------------••---------------•-------- --R --.- ---------••--•-------•-••-------------••-••-------•--•-•----•---••--•----•--•--••-----•-•---------•--------•------•••----•-•--•-----••---....-••-•-••---------•--•-• .0•- ............................................ -------------------------------------------------------------------------------------------------------------------- -------...............................----------------••--•-•-••---•----••-••--•---•------------- I hereby ca ' prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a law , and' s and regulations of the San Joaquin Local Health.pistrict. �//Y t.:,. (Signed)----------------- --- ------ . /� --------------"'. ?1ow ----'------ ------- ---------------- (Owner and/or Contractor) BY: ,/ (Title) --------------------------------- (. 0 =(Plot plan, showi size of lot, location of system in relatio buildings, etc., can be pla on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -•---------------------- ----------------------------------------------------------------- DAT@.�'---------------------------------------------------- REVIEWEDBY...................... - --------------------------------------------------------- •-•-•- DATE.......---------•--•----------•-•-•-•------------------. BUILDING PERMIT ISSUED............ ------------------------ ....................................... DATE Alte ns a r r�ecdommendatiyo� .--/------ _-- ..---_...._ ..................... ---------- wT a+' `� / -W t,...........J..aP°'4 ________ .i ^'rb` Y _.. .. - - __.... ............. ,. . --•---------•---•......... . ........................ -----------------------------•------------------ - -- --------------- ------------ ---. FINALINSPECTION BY:...... •---------------- Date-------------------1-- --.................................................... 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-9-2M ; Revised W-2100