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y � � APPLlCAT10N' FOR SANITATION PERMIT Permit No. AI (Complete in Duplicate) Date Issued 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 Co Ordinance No. 549. p y ----- ..�(�^---`-' `�.'------p------ --W-' 'F"_'#_4.e�----------------------------•-----------• , JOB ADDRESS AND LOCATION____.�- _-- :---- ..�-----�- � / Owne'r's Name -7 7�9• =__ [ l 1 1.7__eo --------- ; Phone 7_ . . _. Address----•----------------- .................. �� ------Me-S Gs, 1� ------------ :: O `'f"°15 - -------------------------------------------------- Phone. � - Contractor s Name_______________________ -- -- Installation will serve: ;Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living, units: __ _ Number of bedrooms .--Number of baths ---- Lot size ____- _-_ --------47.____________-_______ Water Supply: , Public system Community system ❑ -Private ❑ Depth to Water Table'_^/ ft. Character of soil to a depth of.3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejZ Hardpan ❑ 1 d Previous Application Made:' Yes ❑ No j9L New Construction-. Yes ❑ No ❑ �. TYPE OF INSTALLATION AND SPECIFICATIONS: x I (No septic fank"or cesspool-permitted if public s ewer is available within 20a feet.] F Se tit Tank: Distance from nearest well- :_U_----__Distance from foundation____.__.________-.Material___________________________________�________._. .. !, t. .r- I. '.... iSae aL -Li Liquid de th_` -�--------------Capacuty_�" - No. of compartmerris-__ 17- Disposal Fieldl?istance from-nearest well---- ------------ from foundation--------------------Disfance_fo-nearest lot line:______________. Number of line s----- „_:-------------..:=-,_._-Length of each line------------------------------Width of french----------------------------------- LA Type of filter material _ __ ____ _______Depth-of filter material-----------------------Total length____....____________. L "5- : -. - •- i Seepage Pit: . Distance to nearest# e I !.a _Distance from foundation____ . Distance to nearest lot line_________________ . __h Number of pits- Lhning materialT'-_.__. -- #,�"Size: Diameter----- -----Depth-_------------------------------: Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- Size: Diameter_____-----------------------.'. - Liquid'CapacifY -------------�--- gals. L , ❑ _._ -------.Depth=___ .='= ----„ ---- = r -- Privy: Distance from nearest well------ -------------= '"-----------,------'---Distance from nearest building-____________--- ___-___________-----. ❑ ..—Distance to'nearest;lot line "` ----------—------------------ -------------------------------------------- ----------------•---------------------------------------- Remodeling a r repairing (describe):-_- __ _ t 1 '-------- --------------•----------------•----:------------------- ---------•-----------------------------•---------- i €- - Y. - - ------------------•----- -------------------------- Phereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe`laws;-wt d .rules and reguI tions of the San Joaquin Local Health District. ! a ( --------- --•--- ---- ��Contrac+or) ' ---------- -------- (Signed) = '`'"� ..------.( ) >E r t------- ---- By:--------------- ` ;----------------------------------------------------_`f Tale (Plot plan, showing size of lot, location of system in relatyn to wells,..buildi gs, a+c., can be placed on reverse side]. i 1 FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY ° --- ----------------- DATE_N_ _, REVIEWED 8Y = Y 4- ----------------- DATE. ----------••-•------------------•-------------BUILDING PERMIT ISSUED---------------------- }--- ------ DATEr. y ____________________________________________----_-_____( . __________.-._-_.__.---_i { ---- --r f Alterations and/or.recommendations:---- - = r----------•----- - k __________ _____ -----_-------------_-----_---______ ___ f/ `---- _ ,. xp ” A !` D �' .. ,r ': r '^'` ate__.- ~A� °- FINAL -INSPECTION BY: . 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 _r ,