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S l5 APPLICATION FOR SANITATION PERMIT Permit No. __3 2-y 7 10 (Complete in Duplicate) ` �.. Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wort; herein described, This application is made in compliance with County Ordinance No. 544, tom' JOB ADDRESS AND.LOCATION r ----------•----------- Owner's.Name---:- -_-- : Is - I Confit actor's Name_____ �N -------------------- Contractor's ------•------- --1 q -- --------- - ------ Phone---- -------------Y = / Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:'__/___ umer of bedrooms i b �. Number of baths __.�___ Lot size Water Supply: Public system Comunity system❑ Private ❑ Depth to Water Table 4 - n Character of soil to a depth of 3 feet: i Sand Z Gravel ❑ Sandy Lo;/ONo Clay Loam ❑ Clay ❑ Adobe /Har'rdpan Previous Application Mader Yes No ( ❑ ❑ New Construction: Yes ❑ TYPE OF 'INSTALLATION AND SPECIFICATIONS: 1 ea ,' tank or cesspool permitted if public sewer is available within 200 feet.] SepDistance from nearest well_____-.___�-----Distance from foundation__...___.- No. of compartments------.------ -- ---------Size-.--_ _- - Liquid depth Ca acita > � P Y--------• •---------- DisDistance from nearest well- 10 .__Distance from-foundation________.___-__._.Distance to nearest lob lin J-'---------- , Number of lines---------- _._ Len ------------ --Length of each Gne g x Q- �� -Width of trench-- - --------------------------- Type of filter material--S �_ _-Depth of filter material-____,(-�-__--_._-Total length___.- ¢--_04 ___--- Seepa Pit: Distance to nearest well 0 -------- Distance from fou dation__ 1_0---------- to nearest lot line_..- Number of Pits------I _ �_-----_-_ ____.-____ __Lining material-Z-1 e.i -Size: Diameter___- Cesspool: Distance from nearest well--------------------Distance from foundation--------------------Lining' , 9 ti. Size: Diameter.-- -------�_t•---•-•->=;.-°----- De,�th.:_---------'-=-----•--------- -------- - ------Liquid Capacity_-- -------gals. 1 Privy: Distance from nearest welt_____________________________ --- Distance from nearest building--, ------ ❑ Distance to nearest lot line_______________________ _ ---------------------------•------- Remodeling and/or repairing(describe]:__ s I /f1 ------ --- _____________________ ______________ _____________________________________________________________________________________„_________..____.__-____--___---___-______-__--____-____-____________._____________-_______.________-___.-_..______-________.____._-._ f I hereby certify that I have prepared:this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules an egulations of the San J aq 'n Local Health Dist ict. $i ned [ g ) •`� 6& i -- ---- - t��--- --------------------------(Owner and/or Contractor] By: . ..__...----•-......--•----- Title)----------- ot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------- -- ----- ------- ----------------------------------------------------------- DATE __!'--•-- REVIEWED BY ---------------------- ----- ---- - ---------=---------------------------------------------------------------- DATE------- PERMIT ISSUED_..___••------------- -- -------------------------------------------------=---------- DATE-------- ' Alterations and/or recommendations:_------------------------ ----------------- -----------------.--_ --------- ---•------------ FINAL INSPECTION BY:� Date---- 40 '�� 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-4-2M 10-52 Revised W-2100