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7 t `1yA1 APPLICATION FOR SANITATION PERMIT Permit No. (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 County Ordinance o, 549. J08 ADDRESS AND OCAT10iV_.- -------- ----- _ f Owner's Na _-- _ !� _ ----------------------------- ----- Phone me Address- y.0`---- / � ------ ----- ------- ------- ----- -------------= Contractor's Name = = it �� '= -------------- - Phone- t� -�� Installation will serve: Residence Apartment House ❑ mmercial ❑ Trailer Court [] Motel ❑ Other [J !! Number of baths __ __ Lot size ----_�-__r_0-�� Number of living units: __ ___ Number of bedrooms � �-- ------------------------- Water Water Supply: Public?system ❑ Community system ❑° Private Depth to Water Tabl9_1- ft. Character of soil to a'cdepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay [j Adob Hardpan ❑ Previous Application Made:, Yes ❑ NO New Construction: Yes No L] . T TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) peptic Tank: Distance from nearest well----------------- _ -Distance from foundation-_._-_-------__.. .Material- _ --_-.------_----- -_-----__-._____..____._____. [ � No. of compartments--------------------------Size--------------------------------Liquid depth-----•--------------------Capacity-----=----------------- Disposal Field: :Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot lin;----------------- 0 J❑ Number:of lines------------ ------------------------Length of each line----------------------------- Width of french-----------------------_--------•-- Type of filter material------------------- ----Depth of filter material----------------------- Total length Seepage Pit: Distance to nearest well--� '__.__W__Distance fr fou atiori_../r�__ ...._.Distance to nearest lot line.__ Number of its.__ ___.__... Linin materia Size: Diameter._..___ Depth------ _._ _---_ \ P / ----- g ----'----,_•.- ---------- Cesspool• Distance from nearest well-----------------Distance from foundation-------------------- material ___---------------------- ❑ Size: Diameter---------------------- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals" , W- t - Privy-. Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ ❑ ^ Distance to nearestdo-t line-- -_____ ' Remodel ng and/or re airing ascribe) F f f�!- �------ ------------ �-�--- ---e-A4 r __ s -------------------- -------- -.--__F----- --------------- ------------ _ __ ---------- - _--_ !i Aff a t , - ----------f� -- - ------------ — --------------------- -----------------------------�/ t I hereby car}i#y that I have pL�ared this application and t�iat the work will on m accordance wlth San da, County ordinances, State and . les regulations-of the San Joaquin Local Health District - - --------- {Signed]---------- •----- - � - -------------------•• -- - ----------------------------- ------(Owner and/or Contractor) G S . y:._....... r = 1 =...._..- (TiTitle= ~' "w' (Plot plan, showing size` of, locatiorfof stem in relation to wells, buildings, etc., can be laced on reverse sid � 9 P �] { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'-' ------------------------- - -------- ----------------------------------------------- DATE REVIEWED BY-------------'---- ----------- ---- ---- ----------- DATE R BUILDING PERMIT ISSUED------------------------------ _;------ - -------------=------------ DATE--- - _ w Alter (ions and/or recommendations:. ------ ! !, � ----------------------------------------------------•--- - -..lF' ...= ;( ------ ' - _ ' ' `-` -- :!_�--'• ---_�_.X _-- �_',•-� ..... _ rh.! �lY �sa!trE –rF ,t_e}�!` F Ft'C� ' J i l S r 1 r ' � a -------t- - ------ . -•- -- 444-4.t.-- �C_ �,---Vic..-- , _ f[,t�t ff _.- :- f ,{ --rt_ x ,V f $�. . "'` '� -••-----------------------------------`------------------------ 2 ---- _.--' --'--- -� ' 5�J FINAL INSPECTION BY: --- ------------------------- --------------- Date--------------------------- . 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