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I! 0 liPermit No. --- .. -•-------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) / Date Issued .-_ _-, I! 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 No. 549. - - ----sa( OC" _v-r--------------------=•----------JOB ADDRESS AND LOCATION-------.'11 . IM -qKa—eu_� - ------------------- --------------- Phone---------=.------- .----------- -------------------------- ---------=---------- --Owner s Name-------------------- Address-._------------_- ------------Address---------------_- ------------- -- ---- , i ----------------------- Contractor's -----------Contractor s Name---- - a_t�NA _ n. Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: -1---- Number of bedrooms -'*"'Number of baths I_--_ Lot size .......7 ___---- X.:__-1 co------ w Water Supply:"Public system Community system ❑ Private ❑ Depth to Water Table kft. Character of soil to a depth�of 3 feet: Sand ❑ Gravel [I Sandy Loam El Clay Loam El Clay E] Adobe Hardpan E]Previous Application Made- !'$Yes ❑ No New Construction: Yes Alf No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P yl, 9 ry _ Se tic Tank: - Distance' from nearest well__ Distance fro f ndation__-la_.--=----MatenaL-__ s� •�ALi uid de ` Capacity - �,1 No. of compartments---o�7.------------- _-- -�--= -- q --------- --• s 3�R_ P p Disposal Field: Distance from nearest well-_ Dastance from foundation---�f_f-----------Distance to nearest lot line----_-.-.-Q--_. Number!of lines---i-----------------------------Length of each line--/a------------------Width of tren -- `�' -- De Depth of filter material---- al len th-� 0^"--- Yp p -. Tot g Seepage Pit: � Distance to material__--_-.___ to nearest well-_liQK Distance from fo^u�ndatio _- Distance to nearest lot lin`__ ------ e vr- Number of pits------ Linin ----- mate Size. Diameter---*3� i------Depth--- - ------------------- ----- ------ g 64 Cesspool: Distance from.nearest well-----------------Distance from°foundation--------------------Lining materia l--.-__-_-.__-.-.-__--___-___---------. ❑ Size: Diameter -------------Depth-------------- ----------------------- Liquid Capacity----------------------------gals. � F Privy:' Distance from nearest well---.---.__----------------------------._____-.-Distance from nearest building-------------.---------------------------- ❑ -Distance to'nearest lot line---------------- -------------------------------------------------------------------------------------- # f I , Remodeling and/or re, airiii describe):------------------ ---`---------------------------•-•--•-----•--•--- -•---=--_----••--------•------------------------------•-=-------------•-----•- ........... .I ---- - ------------------------------------------------------------------------------------------------------- 1 it - - ---------------------------- --------------•---------------------------- ----------------------------•-•-----------------•----------- _ I hereby certify t I have prepared this application and that the work will be done in accordance with Sen Joaquin County f. ordinances,-State Slaw 4an rules and egulations of the 5a aquin Local He th Distric ----------------------------- (Signed) Contractor} s ------------- ---- ` x i ----------- By----------=------------------F------•----------------------------------------- - - (Plot plan, showing size of lot, location of system in rela o to wells, buildings, tc., can be 'placed on reverse side)., FOR DEPARTMENT USE ONLY A , APPLICATION ACCEPTED BY DATE ---•-----------------------•--•-------------------- ------------- -------------------------------------------------------------------------- REVIEWEDBY-------`------------�` --------------------------------- ---------------- •---------------------.- DATE_-- % ---------- - BUILDINGPERMIT ISSUED------------------ ------ - --------------- DATE---------- -------------------------------------- Alterations and/or recomm"endations:------------------------------- ----------------------•-•-------- •----------------•------'---------•-- =--•--------• ------ -------•------- -- �i, ---------------------------------------••--------------- ---------------- ---- - ---------------•----------------------- �1 -- = -- -----=------------------------ -------------------------------- ----------------------- . --------------•---------------- ----------= Date----------- --- :7--------------- -------=------- -----------------=------- 5 / FINAL INSPECTION-BY:.:---------------- �� II SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 8!4 north "G" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revised W-2100