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y APPLICATION FOR SANITATION PERMIT Permit No. J—C_7< l� (Complete in Duplicate) '4 Date lssuedV __'-Z__�'` Applica+ion 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 Ordifiance No. 549. L e * ------------------------------------ JOB ADDRESS ND LOCAT 41...6- .-- � - e ----- --- - ----------- -f------------ --------- Owner's Name---------- - 11 :�.:.� --------------------- Phone ~ _ . ,; .. ------------------------------ Address---------- --• •. ---------------------------------------------- ------- -------------------------- Contractor's Name---- --- -- ---- •- - -- --------- ------••----------------•-----------------------------•----•--------- `-------------------- Phone----------------------------------- Installation will serve: Residence [1 Apartment House E] Commercial ❑ Trailer Court ❑ otq E] Other !❑ 4-Number of living units. _. __- u _ __. 'umber of bedrooms __ Number of baths .1____ Lot"size ____ O__-_�1-149_ ___________________ Water Supply:—Public s stem Cornmuriit ps stem' Private' De th to Water Table ----------ft. Y Y Y ❑�� ❑� P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe &/Hardpan ❑ Previous Application Made: Yes ❑ No W New Co6struction: Yes VNNo ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: t {No septic tank or cesspool permif+ed if publ+c sew_er i available within 200 feet. . - 1 ""r O Se tic Tank: Distance from nearesr well __._____�istap�e fr four�dation___l_ ..�._____. ate�ry' _ ______ P� r 1 __Li Liquid d th-r �"` _ Ca ecit ____ I. No. of compartments r... . -! �rz q gyp. P Y Dispos 1' Field: Distance from neareost � Q-_--.- istance from foundation._�J�__ ....___ sanceto nearest lotine_ __ � +t ri Width of trench---------- - -� --------- Number of lines------- Length of each line_---------- - >> -- --------------- Type of filt6r matey �Pepfh of filter material____.-____af_S __.Total length__:____-__�_ �___________________ Seepage Pit: Distance to nearest well---------------- Distance from foundation...________-_-___.Distance to nearest lot line----------------. ❑ Number of.pits-----:-1----- Lining material..!--------------------Size: Diameter-----------------:-----Depth--------------------- ------------ ,, � a f Cesspool: Distance from riearest well_______________-0 Distance`,from foundation.________ _:____.Lining material-------------------------------------- I '� ' ❑ Size: D;ameter--------------------- : = }`_:Depth- = -_--=------- - '--_----Liquid Capacity . gals. Privy: Distance tfrom nearest well--------------------------------- ------------'.---Distance from nearesr. building---------------------------------------- - 4 , .. - r' -----'-_____ J-________'-------------------------------------------- Remodeling ------ --------------- -------- Distance to nearest lot line----"----`-----------------=�--=--------------•---------- �----- ..�": - Remodelingand/or repairing (describe):----------------------------------------- -----------•-----------•------------------------------------------------------------- -------------- - ----•-------- ____________________•_--______..___....__________-_____..____._____________._._._______________-______________-_______________--__________.__._-_______________.______________________._________-________._________L._____.__ s1 --------------------------•I------------------------------- ------------------•-------------------- --•------•--.--------•- E c. I hereby certify that I have re a`ed this-application and that the work will done in accordance with San Joaquin County ordinances, S e laws, d ru�S n ro ulations the San Joaquin Local Health District. (Signed)---• •-- ----- --- --------------------- ----- - - -- � .-R -------------------------:-------- -�---------------------(Owner and/or Contractor) By-----------------_----------....--------------------------------------------- ----------------------------- {Ti+le (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 y APPLICATIONACCEPTED BY--- -- ---------- - ------------------------------- ----------------------- DATE-0 - ---------- -------------------------------------- REVIEWED -------- ------I------------------------------ REVIEWEDBY----- --------------------------- t------------- ----------------------- DATE, -' BUILDING PERMIT ISSUED------- -•------------------------- -------------------------�---=-------------------•-------------- DATE..--- , ---------------------.--.--.--.--.--.---------------------_--------------------- Alterations and/or. recommendations------- -----------------------------------------------------------------------.-------------------------------------------------------I ------- -----------•---------------------------- - ---------.---�-•-- .. z ! ' +w-. ----------------------------------------------------- t ---------- --------------------------------- ---------'------------------- ------i-------------------- -- --------- --------- INSPECTION`S Date--- �,,,� ` ---------•---- FINAL' 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--4-2M Revised W-2100