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s ' ' APPLICATION FOR SANITATION PERMIT l/Per No. �_-� 1 {Complete in Duplicate) -v 0Date Issued !____ _... X1 �= Application 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 Ordina ,�e No. 549. j54S JOB ADDRESS AND LOCATION____-- ---_- � •Graf .-- °---------- ---------- Owner's Name �^ L 1 1� C S'1.aa------------------------------------------- Phone--------------------------------- Address-----------------------A__Ll---- ------] Contractor's Name.. � ---------------------------------------------------------- Phone.---- - o 2------- Installa+ion will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms _2"__ Number of baths J_____ Lot size ---- [/ ___`s`__ 44 ------------------------ ; Water Supply. Public system El Community system El Private 9 i4 Depth to Water Table ft. Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ 5andy Loam ❑ Clay Loam ❑ .C•lla-�y ❑ A,d{obe� Hardpan ❑ Previous Application Made: Yes ❑ No �9_ New Construction: Yes ❑ No ❑ lC •�► TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �PptiiccT nkc Distance from nearest well________________Distance from foundation--------------------Material_________________________________---________- t- off Z - 1 No. of compartments-------_--JJ --------Size--------------------------------Liquid depth-------•------------------Capacity------- --------------- Disposal Field: Distance from nearest well-1taeo_`_-----Distance from foundation___ _-----_--Distance to nearest lot ° Number of lines------1--------------------------Length of each line_____,P r--------_--.Width of french---- Type of filter material._r".4-______Depth of filter material-___--_1_��______Total length____ _'_________________________ Seepage Pit: Distance to nearest well-_W?- _________Distance from foundation---c�.4?.'".___.Distance to nearest lot line---10- _. Number of pits--------I------------Lining materialC_ � d 4____-__Size: Diameter____-'_-3_"--------Depth_ °_ __._ __________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______-______________________.______- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------.-gals. /t Privy: Distance from nearest well-________________________________._______------Distance from nearest building--------------------.--------------------- (A ❑ Distance to nearest lot line--_ --------------------------------------------------------------------------------- -------------------------------------------------- 1Rm deIing and/or repairin (describe)-----------------=----------------------------------------------------------- --------------- ------ ----------------•----------.....----- -1 `..._L�.v.,..n.- 1 ,,,. t-,�---- -nom..- �r = ---.-- -- - --------- ------- ------— = .r- �_.. — - -----------•- r --- -- - ------------- ---------- hereby certify h t I have prepared +his applica+ion and that the work will be done in accordance with San Joaquin County ordinances, State;law , and rules nd regulations of the San Joaquin Local Health District. . (Signed) _ =------------------------------- ----------------------------------------------------------------------------------------------(owarer' yr Contractor) Pik By=--- fE'=' -----------------=--------------------------------------------------(Title)---._ ��_l�r^�'2_a4�_�_1'' --------- (Plot plan, showing size of lot, locati�of of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- --- ---------------------------- DATE------------- REVIEWED $Y-------------------------------------------- --------- - - ----------------------------------------- DATE ��;- -Z(�----�---�------- - - . BUILDING PERMIT ISSUED------------- ------------------------- ------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations-------------------------- ---- -- ------- ------------------------------------------------=----------------------------------------------------------------- ------------------------------- ----------------------------------- -- ---------- ---------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ----------------------------I-------------------------------------------------------------------------------------------------------------------- ----------------:=---_------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- --------------------------------------------- --------------------- FINAL 1NSPECTi01\1 8Y: ------------------------------------ Date `--- -------------------------------------------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+ree+ Stockton, California Lodi, California Manteca, California Tracy, California «; ES-9-2M 8-51 Revised W-2100