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c6l-.,,I 5 APPLICATION FOR SANITATION PERMIT" Permit No. _92.1.7----..._ (Complete in Duplicate) .r S f7 Date Issued --- ---._.-,�_--.-- -�qpplication is hereby made fo the San Joaquin Local Health District for a permit to construct and install the work herein described. al�iis application is made in compliance with County Ordinance No. 49. JOB ADDRESS AND LOCATION.___-- - -- -------------------------- Owner's Name----- -- ---------------------- Phonp��,71 .. .. e ---- Address....... A ry------- ---------------------------------------------------------•- i Contractor's Name--------------- : : ,1 " "-��""'"----=------------------------------•i-------------------•--. Phone Installation will serve: Resi ence Apartment ouse Commercial M p ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunit-- Number of bedrooms j--- f j- -- - Number of baths Lot size ...... I Water Supply: Public system Community system ❑ Private ❑ Depth to:Water Table_.,ift. Character of soil to a depth lj f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ .Previous Application Made: Yes ❑ No�i' New Construction: Yes No ❑ ` ! TYPE`OF INSTALLATION AND. SPECIFICATIONS: ' 44 (No septic Tank or cesspool permitted if public sewer is available within 200 feet.) from nearest well—��_-Distance from founds - --.x--_-F------Material---3_r1.Grf/v Septic( Tank: NoDist f f cance ompartments--_-.�-------------_-Size_'-,LP Liquid depth-_ ------_-_._-Capacity. _,444' � 1� 0 Disposal Field:/ Disfiance from,nearest wel�ix� -_Distance fro foundation--j---- .---_.Distance to nearest lot line---- Number of lines`-------- -------------- ------Length of each line-------- -;,`----._.Width of trench- _Type'. of or filter material ___ p I 1 I I! -,. � Depth of filter material-- Q_-----:Total length----------, �--------------- I�umfber of nearest well`" ; Distance from f ndatiore''__- / s_.. ..Dis}ante to nearest lot line- e Pi t Distance to pits------/-__-----------Lining'materlalG� ' Size: Diameter___ De th__- C ess ool: Distance from nearesf'well-------------- t l p ,I _-Distance from foundation--------------------Lining material---__---__--___--.----__-._______-_, ❑ Size: Diameter------------------------- ----------De th---------------------------------------------1 Li uld Ca acit pq P Y - gals. Privy: Distance from nearest well---------------___---_------------..-.-___-----Distance from nearest building ------ ------ -------- IDistance to nearest lot line- ---"-------------------------------------------------.f i ------- -------------------------- -------------- -- Remo -------- ----- Remo g and/or rep rgescribes -- -Z - 1 # 1 . = ---- . - .---- �. --- - ----��-��----•-- •-�•-------- - ..- ----- --------------- r --------------- y I-----------------'--------•-----•- h e6' ce I that have prepared this application and that the work will be donel in accordance with San aquin County ordina es, St a laws, d rules and r`gtb ions of the San Joaquin Local Health Disfrict. (Signed). ] ----------------- -- --•------ --------------------- Contractor) By.....- _ -;. ------------------, = `------------------- ---(Title- - ----- � (Plot,plan, showing size of t'ot,']ocation system in relation to wells buildings, etc. can l � g , be pi on rever Sid FOR DEPARTMENT USE ONLY, t �I APPLICATION ACCEPTED BY--------------------------------- ------ DATE--------------------- REVIEWED BY---------------------------1� ' = �: ' ` - - -- DATE---- r --------------------------------------- SUILDING PERMIT ISSUED----.!1_..- - - ---------------------�--------- DATE------- Alterations and/or recommendations:--..--..- --_ v , I� -- - ----------- ----------------------------- ---------•._-_..------------------•-------------•-----------------------------• �- - 41 .....•---- . --- ------------------------------------------------- --------------------- ------------------------- - ----------- ------• • --- ------- r -------------------------------- _(_)FINAL � 4J ' 'FINAL INSPECTION BY: r - ---- -- ----------- Date-. - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Mlanfeca, California Tracy, California ES-9---2M 10.52 Revised W-2100