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Permit No3yj-------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Lw 141 Date Issued ------f,------ ---- gA install the work herein described. plication is hereby made to the San Joaquin Local Health District for a permit to construct and application is made in complianie with County 0 din ce No. 549. JOB ADDRESS AND OCATION__ _Ax--- --- -------------- o�4 Phor-----------4� o s---------------- Owner's Name-_---- Address------ --------------------------------------------------------------------------------------------------- -------- --- - --------- --------------------------------=---------------------- Phoneof 4Pil(J97------ Contractor's Name--- Installation will serve: r Residence Bo' Apartment House [] Commercial 0 Trailer Court E] Motel E] Other 0 Number of living units: Number of bedrooms Number of baths ___l__ Lot size - Number Water Supply: Public system F� Community system D Private O�/Depth to Water Table --Y& Gra4 ❑F Sandy Loam E] Clay Loam E] Clay [3 Pan El Character of soil to a depth of 3 feet.' Sand E] Adobe 2/Hrd Previous Application Made; Yes E] No New Construction: Yes El No X ?I TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) from undation----- Materialia. -0----------- --------------- Septic k: Distance from nearest well----2d----Dist anc __4_0---- xn �'p& fh! T7&--------Capacity N�. of compartments----------1�-----------Siz6_.4_ - �Iorl_iquid depth-.--------------------- --- ----v--------- No. Distance from nearest w �l -00--------:Distance from foundation-_6f0-__---.Distance to nearest lot line Number o� lines---------- T trench.----Length of each line------- B--__-_---f---.Width----Width of ------------------------ Type of'filter material------V. ----Depth of filter material-_--- _Total length-------- nearest lot line---92- d Distance from fou�dation----- Distance to ----------- Seepape Pit: Distance to nearest well ---- -- ---7------ lid Number of pits.---------l-------_---Lining material_CCA"__.Size: Diameter-------0_2.....Depth-------------r--------------- Cesspool: Dista6ce from nearest well-----------------Distance from foundation-----_- ----------Lining material-------------____-.--_---.----_--.-.Size: Diameter------ -------------------------------Depth-----------------------------------------r-----------Liquid Capacity- --------------------gals. Privy-. ' Distance from nearest well-----------------------------------_------------Distance from nearest building-----...-_.-_---____-----_-__---___-------. Di'stance to nearest lot line----------------------------I------------------------------------------- ------- ------------------------------------------ -------------- ❑ Remodelingand/or re'pairing (describe)---------- ----------------------------------------I----------------------------_-.1------------------------------------------------------------------ --------------I---------------------- ------------------------------•------------------------ --------------------------------------------------I------------------------------------- -------------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -------------=-------- -----•---•------------ -------------------------------------------------------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be,done in accordance with'San Joaquin Cou'6fy ordinances, Stat aws, and rules and regulations of the San Jo uin Local Health District. f_elpftr and/or Contractor) (Signo (12-p-- ----- ---------------------------------------------------------------------------------------- BY------ ----------------(Title)--- --- ---------------- 0- *- -- --------- --- --------------------*-------------------------------------------- (Plot plan, showing size of lot, location of system'in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------ ---------------------------------------- DATE-- ---------------------------------------------------- REVIEWED BY --------------------- --------- ------------- ...... - -------------------------------------------------------------- DATE - ----------------------------*------- -------------------------- BUILDINGPERMIT ISSUED------------- -------------=---------=----------------------- ------------------------------- DATE---------- - ------------- ------•------------ Alterations and/or recommendations-- ------------------ -----------------------------I----------------- •-------------------------------------------------------------------........... ------ --------------------------------------------- -------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ---------------------- --------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- - --------------------------------------------------------------- ----------------------------------------------------------------------------- ------------- -------I------------------------------ ----------------------- --------- - --- - ------ -------- ---- ------------------------------------- - - FINAL I N S P EC T 1 0 N B Y:.--__-_ 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 10-52 Revised W-2100