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APPLICATION FOR SANITATION PERMIT Permit No. v.`_ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con rut and install the work herein described. This application is made in compliance with County Ordinance No. 549. 573132 Altao+nr JOB ADDRESS AN ppCATION ------110.4.)-se/1� "--L1-m7nmD/PE�-- -----A.10111?4-11/° Owner's Name------ -------- © /►J -W -- ------- Phone---G1 ...... Address -14---Zile ----------------- Ttm..-------- -------------------------------(--�--`-----�---•+------------------•- Contractor's Name------------ fAfl�xu- 17-_".� �.------------------------------------------------------------- Phone.../z-•---1.-6 7_--- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other [—]_ Number of living units: ----- Number of bedrooms J___ Number of baths . Lot size _J___ W_C-------------------_____________ Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table #Sft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ '1 Previous Application Made: Yes ❑ No X New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well./400------Distance from foundation.._le------_-.Mater„I--- -=� ---- ---- ------------- No. of compartments__1�'--____-.-_-.--_Sizqs�'"��__"�.b_*Liquid depth__,.' ,� _____________Capacityl�Qfi1�'�'___ S� i Disposal Field: Distance'from nearest well._-/D O____Distance from foundation__,-----------Distance to nearest lot li a.j`__,..... of J9Number of lines____ -R—)----Length of each line----7�•.�0._ .��_-----Width of trench___,�--•__'�'____________________ Type of filter material/_;L_-_hX Depth of filter material----- ------____._Total length_____-�.5------------------------- See�e Pit: Distance to nearest well__/!PC.........Distance from foundation_,l�f__I_.__....Distancp to nearest lot line_-Is -. _- Number of pits.&I' -10---Lining material_j612!_CX___Size: Diameter_-pfd----------Depth__17Z--17Z __________________ 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_____..__-.-_._----___--.---._-.-_._-..._. ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------------------------------------------------------- Remodelingand/or repairing (describe)------------------ ---------------------------------------------------------------------------------------------------------------------------------- ------------ ------------------------------------ -----------------------------------------------------------------------.....................................---- ------------------------•---------------------------------------- • 1 hereby certify that I have prepared thisa plication and that the work will be done in accordance with San Joaquin County ordinances, State la , an r s and rtgulati of the San Joaquin Local Health District. (Signed) I________ ______________________ _-. ___Owneraa or Co ractor By:.... ( ) Title------ - ------- - ------ --------- (Plot plan, showing size o lot, location of system in relation to s, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- ---- - ------ - t '------------------------ DATE---- ” REVIEWEDBY--------------_---------------------- - -- -------- - ------------------------------- ----------------------------_- DATE-------------------------------------.................... BUILDING PERMIT ISSUED----_----------- - -------------------------_---..........................--------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------------------------------- ------------------------------------------------------------ ----------------------------------------------------------------------------------- ------------------------------------------------------------------------------•------------------------------- --------------------..---- ----------------------- -------------•----------------------------------- ----------------------- --------------------------------------------- --------------- -------------------------------------------------------------- ---------------------------------------------- --- }- ---------------------------------------------------------------------- --------- ------------------_-- -- •---•----- ------ ----------------------- ----------- -----------------•---- ------------_------- FINAL INSPECTION BY-----------------61.U_S------------------------ Date----_q1Z_"`1�-- /*5.j----------------------- ----------------- 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