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APPLICATION FOR SANITATION PERMITo __ .._ � � } S• (Complete in Duplicate) ``ff S.] �� b_ M Date Issued -7 7 ....� . r -T-077- Y`®---�7 Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h rein described. . This application is made in compliance with County Ordinance No. 549. /� Ql� �s� 3}_P�ri�A� 2� I 1 C •- JOB ADDRESS AN LOCATION- : �? B--O i- a r{/ a 4L(W;?,1k _ Owner's Name--------- Qn.k° tll�2Q>t" -'L------- -- - ---------- Phone___,S_�------------- �o Address N �-- ----1'!at-6--- Lan-e------- Contractor's Name. _fe_f- ? / ----------------•-------- - f - Installation will serve: Residence Df Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ .�. Number of living units: j_._ Number of bedrooms .-2-- Number of baths __I___ Lot size .-/1.A-------•------ ------ �1 Water Supply:- Public.system ❑ Communitysystem ~ y ❑ Private � Depth to Water Table �_" ft. Character of soil to a depth of 3 feet: Sand-El Gravel ❑ Sandy Loam ❑ Clay Loam•[] Clay ❑ Adobe�' Hardpan ❑ [`p Previous Application Made: Yes ❑ No JQ New Construction: Yes ( NoF❑- r' TYPE OF INSTALLATION AND SPECIFICATIONS: � i • � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr wel Q --- Distance from foundation__ __ dMaterial �- - -� -Q----•---. ----� �.� - I No. of compar#men'ks_____-___- --------Size_s _hfr_ Liquid dep�h--. _��------;CapacitY--.-- dpa Disposal Field: Distance from nearest well�Q-�---Distance from foundation___�._0__._____Distance to nearest lot '- Number of lines________ ___ ________Length of each line_= -_Q_"' 0r_,Width of french-at - -t Type of filter material____ - _--Depth of filter material___ 8<-----------Total length_------,/��!-- Seea e Pit:F Distance to nearest well_____________________Distance from foundation_______.._________.Distance to nearest lot line______ ----------- ,,;,,. ❑ Number of pits-----------------------Lining material_--------------------Size: Diameter-----------------------Depth----------------------.---_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------.Lining material_____________________________---_ ❑ Size: Diameter--------------------------------------Depth------------------------- Lrquid Capacity gals. 41 Privy: Distance from nearest welL__.__-.._------------------------------_-----Distance from nearest building--------------------------------_-:_-1.4 ElDistance to nearest lot line------------------------------------------------------------ 1 Remodeling and/or repairing (describe):------------------------------------------------------------ �.. - ----------------•----------------•----•------------------------ ----------------------------------------------------------------------= ----------- •- �Y - .may / ^ _________________________________________ ____ -------- ______ ___________ ________________________________________________________________________________________________________________-------------------------- I ___________________________�_._. I hereby certify.f t I ave prep ed this ap a#ion and that the work will be done in accordance with San Joaquin County ordinances, State law an rules and ulation the San oaquin Local Health District. s (Signed)--------------------- - ---------------- -- BY: ontractor) -- ---- --- ------ Title - (Plot plan, showing size of lot, location of system in rel tion o wells, buildings tc., can be' placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- vKd REVIEWED BY DATE_ : j• --•--�54------- ------------ -------------------•------------- ••----------------------- DATE---------------------- • ------- ---------------------------- BUILDING PERMIT ISSUED ------------------------ ------ DATE-------- Alterations and/or recommendations______________________________ �. ------------------------------•----------------------------------------------- .. ` ----------------------------------- -----------—-''----- -____F_______________________________________ --__-_-__.._ -------------------------------------------------------_-------------------------------------------------------------------------------------- T ------------------------------------------------------------------ FINAL INSPECTION 13Y•.41-__` ----- � - y t Date --- ---- -Sly SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" 5+vee+ Stockton, California Lodi, California ' Manteca, California Tracy, California -ES-4-2M Revised W-2100 1 _o F