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� APPLICATION FOR SANITATION PERMIT Permit No. .�{G�. _.. (Complete in Duplicate) / Date Issued -p-133 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein scriibbed. This application is made in coir`pliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION --- -S.F---- ----------------------------------------------------------------------------------- Owner's Name---------------------- �i. 'e I1 - Phone_ ---- --Z--a-/ Address-------------------------------------•` ------N-Or---- . '. .E - ------------------------------------------------------------------------------------------._.. Contractor's Name--------------- I! ------- C-----------------------;--------------------------------- Phone----- 46 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Ddcv6cf 6�_l Number of living units: _ Number of bedrooms A. Number of baths _ Lot size _____2 ..�''►___ e-&E4---__---__--_-..--._ Water Supply: Public systeml'.X Community system ❑ Private ❑ Depth to Water Table A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ' Sandy'Loam ❑ Clay Loam ❑ Clay ❑ Adobe NJ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction:'Yes D' No E]TYPE OF INSTALLATION A'ND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__tA .___Distance from foundation-10--__.._.__.Material__-clC- --IL% ® No. of col partments --------------------Size._ x_ �_-_ :___Liquid depth__ ___----------- _ Capacity___l Q_ , Disposal Field: Distance from nearest well-_K0_#11W_Distance from toOndation-_�f----- Distance to nearest lot line_._. pV Number of lines----I------------------------------Length of each line----10-Q-'------ t4 ----.-.Width of french---Z- -' -------- Type of filter material-l_�2:. Rk----_Depth of filter material------ length__1_0_d0__`._______-_-_-___--__. Seepage Pit: Distance to nearest well_1404C--.--_Distance fr fo ndafion_/_1 _ ._..Di tante to nearest lot line_____.____ Number of pits--1____________------Lining material�l�c.L _.Size: Diameter_.! '1.___Deptn_cr�.J"._'___.._______.___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.-__---_-_-------.____.---.--------. ❑ Size: Dia efer------------- ---- -------------------Depth--------------------------------------------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest yell-----------------------------------------____..-Distance from nearest building----------_--.---.------______._._.------. ❑ Distance fo nearest lot line-------- ---------------------------------------------------------------•----------------------------------------------------------- ---------- Remodeling and/or repairing) (describe):-------- - ------------------------------------------------------------------- ----------------- -----------------------------••----------------•-------- ------------------------------------ --•-••-----••----------------------------------------------------....------------------------------ --------------------••---------------------------------------- ------------- -------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------ dM I hereby cer that l have pr pared this application and that the work will be done in accordance with San Joaquin County ordinances, ate la s, a ryles regulations of the San Joaquin Local Health District. • I� L' ____-_---- -- ------ a Contractor (Signed) -------------- ----- --- By:------------------••---•-•--...--i�--------------------------------- ----------------------- r (Title} Q (Plot plan, showing size of loi,�Iocation of system ' elation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ;1. APPLICATION ACCEPTED BY----------------_------------------------------------ - DATE---------j�lJ ( " w REVIEWEDBY------------------------iM---------- ------------- -----------------------------V._.--�------------------------------- DATE---------------------- ---------------------------------- BUILDING PERMIT ISSUED---!M----------------------------------------------•-------------------------------------------------- DATE---------------------------- --- - --------------------------- Alterations and/or recommenclations:-_------------------------------------------ -------------------------------------------.--------•---------------••--•-------------------- I ------------------------------------------------- -�I----- --------------- ------------ -------- ------- ----------------------------------------------------------------------------------------------------------------------- IM I)----------------------- ----•- ------------------------------- ----•------------------------------.-._. -------------- --- -------------------- - - i 'y - Date- ---------------- ----:-- FINAL INSPECTION BY-------------------- •- -----�1---- ��i .- - ---------------------------------- SAN ------------------ -------------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-9-2M 0-52 Revised W-2140 f