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APPLICATION FOR SANITATION PERMIT Permit No. �v:!571_3___-_-- (Complete in Duplicate) 7 5 Date Issued Applica}ion is hereby made to the San'Joaquin Local Health-District for a permit to construct and install the work herein described. This appl14, ication made incompliance with County Ordinance.No. 549_ 77-5 00� JOB AE}DRESS AND LOCATION_-___ �o.�� . s �_ n Owner's Nam [.1 -r 4.? /Ti��QIL'. _, _1C� -- - -- ----- Phone/ J'�7 Z. (2 : � . _ _ .-------- - - -----.--- Address------- •--`--------- ` --- ----h�.---- -- - -----------------------------------------------------------------------•- Contractor's Name----------------------•-- _ _ _ 'r'_ `_�_ ons�f~ e # -- - .---•-i-0-- --------------------- Phone--"- )--!?S -f?Q--- Installation will serve: Residence 9' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ SYS t Number of living units: _._£t_. Number of:bedrooms _-_ Number of baths __--_ Ldsize ____________________1_-_�1_�-_1 90 Water Supply: Public sysfem ❑ Community system ❑ Private A Depth to Water Table 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: YesNg �4 k _ TYPE`OF INSTALLATION AND SPECIFICATIONS: ' t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ry Septic Tank: Distance from nearest well----4Ts_ Distance from foundation_---- ------Mater'al---- ------------------------------------------- z No. of compartments----v_�=.____-___' -----Size--- ___Liquid depth__.._K'________________Capacity___&!0eaz Disposal Field: Distance from nearest well._: .5_.:.. !Distance from foundation-----L0_. .....Distance to nearest lot line....t...... "1 Number of lines---•.I-_ .�---�-A�,"/"°"'--,------Length of each line-------q--..................Width of french----- 3�------------------- € Type of filter material---ftl :--____:_.__Depth of filter material-__-1 k ....i.-___Total length----- ..9_P_ ....................... Seepage Pit: i Distance to'nearest well-_"_------------------Distance from foundation_____::"______='Dis 'tance to nearest lot line--------------- �I'1 ❑ `" Number of pits----------------------Lining material--------------- -----Size: Diameter---------------_----__-Depth---------------------------------- Cess -----------_. Cesspool: : Distance from nearest well tDistance from foundation_______'_,--_'-,--.Lining material_____________________________________� L „c,,�:;c,� mom,Size:.Diameter.-------s--------------=---- De th i Li uid�Ca acct els. - ❑ P -------------------•- ---- — __.;. - 9 p y--------------- ----•-:--g k Privy-, Distance-from nearest well_'__________-----------------------------------Distance from nearest building--------------_______________._._____._.) Distance to nearest lot lrne. y___ -* �- ' --------------------------------------------------- "-T === Remodeling and/or repairing --------Ap1_� 1e------- ----•• - _ �Si ----------------- CC / p g .. '" f -----------------------------:---------------------------I----------- s t. + E i k c -----------•--------------------------------•-------------------------•------- ------------• -------------------------------------------------------- Lhereby certify that 1 have prepared this application and that +he work will done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District., n (Signed) f ------al --------- ------------- -------------------------------------------- {O era d/or 'Contractor) By:. ... - y (�51 Tale (Plot plan, showing size of t, location of system in relation to wells, buildings, etc., can be;placed on reverse side).' 11. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- "/'-' - ----------------------------- -------------------------- DATE-----7-ZS - ---------------------------� REVIEWEDBY------------------------------------------ - ------------------------- DATE--------------------------------------.........•••--------- a BUILDINGPERMIT ISSUED--------=-------------------------------------------------------------------------------------------- DATE---------------------------------------•----------- -- Alterations and/or recommendations: ------------------------------------------------------------------------------------ ; -------- ----------------- ---------------- -------..._:.._... -----------------------------------------------------------------------_------------------- �4 -------•-- -----------------------------------------------..,--------- --------------------------------------------------------•-- =-----------------------------------------------••---------•---------------------- ----•-------------------------------------------------•---------=--------------------------- ---------I------------------------------------------------------------•-----•---------------- --------- ------------------------------•------ -------- -----------------------------------------------------•------------------------------- ----•------ - --------- --- ---------------- FINAL INSPECTION BY:. --- ----------------- --- Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 136 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100 V