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APPLICATION FOR SANITATION PERMIT Pernr't No.�4�...- ` ..,._`. L (Complete in Duplicate) Date Issued Applica-%n 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 Or finance No. 549. JOB ADDRESS AND LOC TION-- -- (C�- - ----- --- ---------�i_20------------- ------•--�-1 Owner's Name------------ Address ---------- �....__ �-C.c�-G 1 ho ' - P `_afs rt= ---------�S Add ress------------------------------- G` Contractor's Name------------- -------Lr .c----------------------------------------•---------•-----------•------ Phone__ ./.6__!_. ?. Installation will serve: Residence CK Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ Number of living units: J---- Number of bedrooms 2---. Number of baths __!____ Lot size __; 's_ __ __._. _ }?U--___-.____ Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table4zoft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)( Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑dz ey- j�_11 F��p -, a"' '7 TYPE OF INSTALLATION AND SPECIFICATIONS: -fy 5 V__ (No septic tank or cesspool permitted if pu c sewer is available within 200 feet.) �Distanc from foundation__ __ Se tic ank: Distance from nearest ell_ � ____ .__.Material___ _ (�---_. No, of compartments A. Size_ -- - -- __-Liquid de th_��.�� _ _ Capacity-t-�__.. - C(' P -- q p ----- j -- p �w7 { ____.___.Distance to nearest lot Dis osaI i . ' Distance from nearest well__ _.r --._Distance from fours ation_____ Number of lines________I_____ _____r._ ___ __Length of each line----3_,.�_---______.Width of trench---- V:�................ W Type of filter material__A ]._`�. _i___Depth of filter material__/9__________._Total length_ _. _______________________________ g -_._ 0-s .__.Distance to nearest lot line___ Q See a e Pit: Distance to nearest welL.�_d_�._ _ Distance from foundation__ Number of pits___.______________Lining material�i� . ___-� ______5ize: Diameter_.s - - -�-----Deptn___ e___ ________________ r Cesspool: Distance from nearest well---------------__Distance from foundation_________.------.--.Lining material--------.----------------------------- El ____.- --------_-.-________.❑ Size: Diameter----- ---'--------------------- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_______________________.____._____._. ❑ Distance to nearest lot line------- ------------------------------------------------------------------- Remod ling and/or repai irlg (descr'sbe):�- __ __ ___`4-.--- _-- __ _____ ------ -T. _ .. ------------------------------------------------------------------ ---------------•---------------- -------------------- ------------•--------------- --•-'f----- -------------------------------------1-------------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------- I ------------- ----------1-------------•-------•-------------------------------------------------------------------------------•-----------•-------------------------••----------------------------------------- I hereby certify that I have prepared his application and tha+,the work will be done in accordance with San Joaquin County ordinance�,`sr-5tafe iaw'f;and rules ad reg�iltations of'fhe San Joaquin Local Health District. • (Signed) { "Contrac+orl By-------------------------------------------------------.-..---------------------------- _-- -j'r-'�------- Title)------ 0� `- ------------ (Plot plan, showing size of tot, location of system in relation to wets, buildings, etc., cap be placed on reverse side). FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY-------------- ------------ ---- -------------------f-f_,S_-{3--.------------------------------ DATE------ ----•-.. .... . REVIEWEDBY-------------=------- -- - --------------------------------------------------------------------------• DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------- Alterationsand/or recommendations:-----------------------------__----------------•-----------------------------------------------------•--------------•----------------------------------- ---------------------------••-----------------------•------•-----I——------------------------------ ----•--------------------------------------------------------•--•---..-----------•-----_--------------•------------------ ---------------------------------------------------•-----------------•----------------- ------------ ----------------...---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------.--------- ---------------------------------------------- ------ ----------- --------------------------------•-----•--------------------•---------------------------------------------------- ------------------------------ . F]NAL INSPECTION BY:------- ---------------------------- Date------>---------------------------------------------- SAN -------- ----- --------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised W-2100