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�y APPLICATION FOR SANITATION PERMIT Permit No, ,.4 � (Complete in Duplicate) Date Issued j/_? -53 ThisApplication is hereby made to the a Joaquin Local Health District for a permit to construct and install the work herein described. ap lication is 4cleFin„c mpliance with County-Ordinance No. 549. 1233 S r� _ ___ r� 4 JOB ADDRESS AND LOCATION__N C o1"h e!^ �,p �� v --_.--ahs_-$. Owner's Name IeY!_[_�_�c]S"-!d�_._.C� o� - ---- - ---------- -------------- ---------------- Address----- .� „j ------------ ---------- Phone------------------------------- -------------------------------------------------------------------------------------•-••--"---------------------- --- Contractor's Name-_____------0,u i, . ------•-•-------------- _ Phone._ q�}0-------- Installation will serve: Residence �ji Apartment House ❑ Commercial ❑ Trailer Court Number of living units: ---I---- Number of bedrooms -3 ❑ Motel ❑ Other -Cl,�rc L� Number of baths __ -,- Lot size _...1-I r Wafer Supply: Public system � Q_x_123------- ------------------- -- Y Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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_h_4"?+_' ---_Distance from fou�ndation____ C�` I� 14 No. of compartments------_- -" � th--.Materia!____�,oh _H_,:t� f" - - ---- ---Size----�X�--�--'�--- ----Liquid depth-----�-�-- ---- -Capacity--/-------------------. ' t Disposal Field: Distance from nearest well---"5W---Distance from foundafion_�_�_t_ - Number of lines_-_______ -_--"_"-_-""" _ "_Length of each line___-____ Distance to nearest lot lin�e____�_____-� Roclr (P- �;----------Width of trench.--Z Type or' filter material -�_____--.___De th of filter material_-__.___-_-" M Seepage Pit: Distance to nearest well_"Yleh-tR6C Total length------ )-ZD-- ---^ Distance from foundation_____._____r__...__-Di�tgjpce to nearest lot line-"✓-_""_-""_- Number of pits-_ --j---------------Lining material_hr eft--- Qom' -- Size: Diameter------------------------Deptn--- �-�------------------- Size. ----------- �-�� N Cesspool: } . ❑P Distance from nearest well-------_---------Distance from foundation._-___""-"""---"__-.Lining materia!_""_-__"._.____-______._-"__.__-__- Size: Diameter------------------ ------- -----------Depth------- -gals1 -----------------------Liquid Capacity-- Privy: Distance from nearest ural) -"-. --" Distance to nearest lot line___ Distance from nearesf building---- ------- ------------------------ Remodeling and/or repairing (describe):______--------------""-- i -------------•-- ----------------------------------- - --- • ----- f l ---------------------•------------------------ i` { ------------------------------------------------"----------- ------- ------------•---------------------------------- ---- ---------•-------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r=egulations of the San Joaquin Local Health District. (Signed)---- , By: "" ---- -"--------------------------------------------------- - _____.(Owner and/or Contractoel—d -------- -----•-- ------------------------------------ --------------------------------------------- --------- --- --- -------(Title)-----� -IAli. � ________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- REVIEWED ________-_-._ -------k--- ------------- DATE---�/-�_z _ REVIEWED BY-------•-•--------•---- --- -- -- 7 - -•'--•--•------- i -- - - ------- ---------------- DATE--------------------- ----- AltUILDING PERMIT ISSUED---------------•- --�-------------------------------------------------------------------------------- -------------•------ erati ns and/or.recom endations: - r- ----------------- -C -----------------^_ --DATE---------- ---------- ----��y 4-,�_ f� x , r _ - - -- ' `' ------ ------ ----------------- ----------- - --- --------- ------------------ FINAL INSPECTION BY:_____... ._`� "+- .� Date I - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100