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ffi V I - Permit No. 4316APPLICATION FOR SANITATION PERMIT ` -- i "f -- ^� (Complete in Duplicate) 1 AAI/ Date Issued c_t2 � Application is hereby made to the San Joaquin Local Health District for a p mit to construct and install the work herein described. This application is made in compliance with County Ordinang"o. 54.9. � ' - 'JOB ADDRESS AND LOCATION------- Owner's Name-------------------- h?_-e---i- +----------------------------------------- Phone------------------------------------ Address.................................. c?D °• (��'�� Ql``4---- = - 'ca 1_ _�i9...... ------------------------------------------------ Contractor's Name--------------------------- 5+ ------------/4--�----------------------------------------------------- Phone----9----- -t/--Q;�------ Installation will serve: Residence„K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: ---I--- Number of bedrooms 1- Number of baths __/___ Lot size ___ -- ------? ___1_____ -__,S________-_ Water Supply: Public system ❑ Community system ❑ Private,®. Depth to Water Table 9&,ft- -f- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [I Adobe, Hardpan ❑ Previous Application Made: Yes E] No,-l9,New Construction: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available withi 00 feet.) tic Tank: Distance from nearest well-----------------Distance from foun ation--------------------Material -__-.__________._.._-__________._-__-._-_.Q No. of compartments------------------- -----Size--------------------------------Liquid depth--------------------------Capacity----------------------'/`,�7 Disposal Field: Distance from nearest well.. Distance from foundation....8------------Distance to nearest lot line__- __�.._ V Number of lines-------I-------�__i--------------Length of each line_4 � __ __--____-_.Width of trench-__ o7___ !---___-_-___- Type of filter material___- -(2k------Depth of filter material------/_g".......Total length__.__ __ "..__-_____.__� Seepage Pit: Distance to nearest well_A_G_QE?__'_-_____Distance fpm foundation----l-6 --_..Distance to nearest lot line------.-_ Number of pits ----materiale �s________Size: Diameter..3_�- __-____Depth____.["'_____-___.__-___ 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----------------------------------------__ N ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify t at I ve prepared this pplication a l d that the work will be done in accordance with San Joaquin County ordinances, State I es and regulatio s of the San Joaquin Local Health District. i (Signed)----------------------- L ----- 1 ------------- ------------ (fir Contractor) - ---- --- By:--------------------------- -------------------------------------------------- ------ (Title)---�1 1 t"lA A �-'�< (Plot plan, showing size of lot, location of system in relation t ells, buildingstc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- --- ------------------------------------------- DATE,- - REVIEWEDBY---------------------- ;1 :1 =--- ---------------------------------- -------------------------------- DATE '�-----------------------.-------------------- BUILDING PERMIT ISSUED---------------------------------------- -- DATE------ V ----------------------------- Alterationsand/or recommendations------------------- ------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY------------#- -- ---- ------------------------- Date---- ----------------- .4; ------------------------------ 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 10-52 Revised W-2100