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Gr I APPLICATION FOR SANITATION PERMIT Permit No. .... .-..�..Y......_ (Complete in Duplicate) Dote Issued Applica+ion is hereby made to the San Joaquin Local Health District fob permit to construct and install the work herein described. This application is made in compliance with County Ord' o. 54 . JOB ADDRESS AND LOCATION... .D . . .. . . .s!7 •........�-1111....: '.. ,�/ ` ^ , ��} �y� ��J �. ....................... ................... .............................. Owner's Name..... .V..Y...`.... i.......1..!'.. 19. -�C. .... .�.].`...... Phone...! •''.�3.�F.1 fes. Address........................ 214.4... . ...... .. It _.. ............,. .. ............... ............................................... ...................... Aj Contractor's Name... .................,1�.. �1.�1.t.� ... .. ......... ............... Phone.l�..:... ��..... Installation will serve: Residericl X Apartment House ❑ Commercial ❑ Trailer Court E] Motel [:] E]Other Number of living units:1....... Number of bedrooms .'7I.. Numj ber of baths 1..... Lot size ....�vg—.X.1.4.e...... Water Supply: Public system )q Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes( Hardpan ❑ Previous Application Made: Yes ❑ No 01 New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n Septic Tank: Distance from nearesi weil...... . .. ...Distance from foundation... ........ ...... Material ........... �j ❑ No. of compartments . ............... Size................................Liquid depth... .. ........ Capacity.............. Disposal Fieid: Distance from nearest well . .. . .D:starce from foundation........ . ......Distance to nearest lot line. . ............. ❑ Number of lines ............. . ............Lengih of each I*,ne.........,.,.... .. ........ Width of trend.............. . ....,........... , Type or filter material.. . .........Depth of filter material ................ Total length.. .................... Seepage Pit: D:stance to nearest we:l. Z}'l.+ni 9 -!Distance om fo'ndation..�.5�.... Distance to nearest lot line f,�... .. Number of pits Q?'l2_...Lining mater' ...Size:...Size: Diameter.... 10........ Depth .3Q... ............... Cesspool: Distance from nearest we I.... ... ..... . Distance from foundation . Lining material.. ........... . ...... ...... ❑ S:ze: Diameter . ..... .......... . . ..Depth............ . .... .... ....... . ...Liquid Capacity.. . ........... .. --gals. Privy: Dis!ance f-om nearest well... ............ ...... . Distance from nearest bu;lding ........... ❑ Distance to nearest !of iire..... ... . .. ................. . ........... A.. ............. .. .......... . . Remodeling and/or repairing 1,dcscribe):... ........ /1J......._ ........... ...........40. . .....,. :!�� . ....... .. .......... ... ............,....................�..............r_ !... !'....... �!r ............. .. . . .. 1111. ............ . _ .. ... 1111. r �. . .. . ,�.,c .�� 1111./ -CC/1 .. .... ............ . ..... ... .. .,............. ......... 1111.r� .. .. 'L :c�......, 1;- .�.... -A....... �... :� �.. ..tfri ... r ............................ ..... ............... I hereby ce ify that 1-have p�ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, acid r Iles �'nd regulatio6is of the San Joaquin Local Health District. r q i (Signed).................... .....�.... . .. i . . .. f.. .......... ........ .. ...(Owner and/or Contractor) � ! 1111. 1111 8y:......................... ...............� I�C _ -�,�..�....�... .,ti,. ............ .....(!tie)..... .. _. .,C4-rt............ (Plot plan, showing size of lot, loc�rion of system in relation( to wells, buildings, etc., can be pla48 on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .......... ... ... . ........... 15 .................................... DATE............... . ..$..-"!T ................. . REVIEWED BY........................ ......... . ....... ..... .. .... DATE..... . .. 1111. 1111 .. . .................. ... .................. ........... .............. BUILDING PERMIT ISSUED. ...... ...................... . ....... ................... ....................... . ...... DATE.... . .. ........... ......... ..... . ........... ... Alterations and/or recommendations:......... ... .. ........... .. .. ........ ... ..................... ........ ........................................................... ..... ... ................ ...... . . .. ...................... . . ... ...... ... .. . ............................................... ..................... ........................................................ . .. .... ..... ....... ....... ...................... . . ....... ...... ........ . ................................. ............................... . .. ...... ........ -........... ................. ......... . . ........... . ............... . .. .1.1.. .1 1—.............. .. . . ...... ........ ... ........... ... . . . ... .. .... . ................ ... . .. .. ...... .......... . ......I ................ ..............—...... . FINAL INSPECTION BY:. Date. . .... . ........... .J...... . .. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--4-2M Revised W-2100