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4 � APPLICATION FOR SANITATION PERMIT Pewit No,, X...._..--.- �,� f (Complete,in Duplicate) i 1 _ / Date Issued _.__.s -_. .,?__!� 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. JOB ADDRESS AND LOCATION...l ..4 S......_.. Owner's Name...... GLI..-sy' _ ------------ -------------------------------------------- Phone . Contractor's Name--------- ------- --- --•------- d�- -- �� Installation will serve: Residence Pg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: _je�___ Number of bedrooms ___!�_ Number of baths .-/- Lot size ----7a__`_X../_ _s"-------------____-- Water Supply: Public system N Community system ❑ Private ❑ Depth to Water Table .414,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No IF New Construction: Yes 2( 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!OW.6istanc Nfro, foundation..,Ml.__..__.Mate�a -- -_____________-- ® No. of compartments-__-__-� _. Sae.Sb,X_X�_ Liquid depth '�-�-_____-_..__Capacity...__ Q_4.. Disposal Field: Distance from nearest wellDistance from foundation------2_a�_.._:_-Distance to nearest lot line._3 ..�.. ® Number of lines. -1-_ _ ,.Length of each line...... S .Width of trench 231!,1 --------------- Type of filter mate ria l__stA of filter' materiaL____Ai'_.....Total length......7_15 .-1__ Seepage Pit: Distance to nearest well-II)AM40..Distance from foundation....$'0 ._.Distance to nearest lot line.-.-,5......... 1 ® Number of pits__._._./_____:____Lining-material_.___. ____'.`___-Size. Diameter_.__.. �?_/--__-____Depth. ___ S_�_________________ 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------------------------------------------- 171 __-•___-______ ----_____.___-__--..❑ Distance to nearest tot line,,.............---- •----•-- -• --. --•--•-- ---- ...................................-•---•-------•------- P Remodeling and/or repairing (describe):------- -------- ----------------------•--------------•--------------- •-•------ •----------•-•---•-------•--- . --•--•-•--•-------------•----------------•--•---•-•-------•--•---------------------------...•----•------------------------------•----------------•---t-----------------------•------•--...................................... I hereby certify that I have prepared this application and that the work will be done in accordance vrith San Joaquin County ordinances, Sta4 laws, and rules and regulations of the San Joaquin Local Health Dis6ict. (Signed) _ .:-----•• •------•----�". ". _.--I( 0-e-C t.(� ( or end/or Contracto Bye .t al W_ ------------------------------------------------------�tle)-- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can`o placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY----•-.. _ DATE •-------- REVIEWED BY DATE_ +: ---------------------- BUILDING PERMIT ISSUED......... ----------------- •------••----•---------•--•--- •--•-•---•-- • -•---•------. DATE.---......................................................... Alterations and/or recommendations:.......--•................................................................................................................................................ ---•------------------------------------------------•---------------------------- ----------------------------------------•------------••---•--------•----------.........--------........------.....---......--•--....------. -----------------------------------•--------...--------•---.....---•--------•-----•--•-•---------------------------------•-----------•--------------•-------••-•-•----•-----•------•-•-----....------------ •-----......... -----------------------•------------•-----------------......--•---......•-••--....•••---------..-_..._......-••--•-•••-•-•-•---........-----•--•-••••....•-------•------••----•••-••-•---•....--•••----•-.......---•....--•-•- FINALINSPECTION BY:................... ----•- -•------ ---- ------------•-• Date.............._.... -----•-_. ....••--•--•-•••----=---•...............---• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South-American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Codi, California Manteca, California Tracy, California ES-9-2M Revised W2100