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` APPLICATION FOR SANITATION PERMIT Permit No. ...�' _ Q \t1 (Complete in Duplicate) •, 1 �' T Date Issued 717. p anion. isLeby made to the San'Joaquin Local Health District for a permit to construct and install the work herein described. Th s application is.made.in compliance with. County Ordinance�No. 549. t r �,j- ��i1C41OCATION.___ r.J JOB ADDRESS AND �____ ___________________✓�j ___ _ {{ --- ' 7 � k s F 1 Owner's Name--------- --- ---- -------------- Phone-�� -------------- Address_.__ .S - = ------------------------------ ---------- ----f � C, --, ----------- t--------------------------- Phone ��-.Z �-- Contractor's Name____ ______ ___ Installation will serve: Residence Apartment House E] Commercial ❑ -Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: __/_- Number of bedrooms : ._ Number of baths`_° ' Lot size ____�_ __ _ _ d____--_-_-__-_-___-_-__ PP Y� Y ❑ Y Y ��" vate❑`t'Depth'to Wate Table ft. Wa+er-Su I Publics stem Communit` s stem'. Pri Character of soil to a depth of 3 feet:' Sand ❑ L.Grav'l ❑ Sanay Loaam E]. C1ay;Loa m 0 ..Clay E] Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No t New Construction: Yes E] No ❑ TYPE OF INSTALLATION- AND SPECIFICATIONS:---.- (No PECIFICATIONS:-- -..(No septic tank;or cesspool permitted if'public sewer:is available within 200 feet.} y ptc Tank: Distance from nearest well_______________-Distanxc: Distance from foundation--:---' Material --- _No. �.�•W� of compartments-=--•-------=---------- -Size- ------------ ------Liquid depth--- ---------------------'.Capacity-----------. Distance from nearest well__...:.....:..:..Distance from foundation "- ^"-°"'"`:Distance-to nearest lot line_____ __________ Dis sal field: ti - `. C�' Number of lines------ = -- I - Length of.eac'h,line_ Width of trench ------------------------------- Type of filter material___ .___- t _Depth of filter material_---------------------1 ;Total length ,�--------------....... ............... Seepage Pit: ` _`_Distance to nearest well ��_____ --,--!Distance from .f"oundation_�`�-�`�Distance to nearest lot line i } ! r r--- Number of pits------- .._____.._ Lining-materiall_�_�_�_ _.+- A---Size: Diameter__1__�_4_':...._-_Depth___ _:_... __- i -- � x _ 4; r - Cesspool: Distance from nearest well= _______:__��__Disfance from foundation �_:�Lining material____________________ ----- ❑ Size: Diameter-- - ..Depth _. = -- :.L I ILiquid Capacity------------------------I---gals. t. f-.. _-V- Privy: r z ; i I Privy: Distance from nearest well----------------------- .'_-_Distance from.nearest building------------------------------------------- -Distance _________________ --- ---- --- ❑ -Distance to nearest lot liner,,- -� . k.. _._"`" . ,.... «+.t- _ "------- -- -- ` ------_. Remodeling and/or repairing (describe}:_ :G�� __________________._ -J------------- �`'� .� ___._-___ -------------------------- I _....______________ --------------------- -------------------------------.------_._._..___..-_______._______-___-____--.-________--_-.___.___---__._____k_ _ __ _ _ ________.________ ____ t ° t t �. -. . __--____________________________________________________________�______-____-___________�___,___-�`--_-_____-----_-___•-.-_-_-_____�_______________--__-._____________-_____.-_____-•___________._.._______________.____ I hereby certify that I have-prepared this application and that the work will be-done insaccordance with San Joaquin County ordinances, Statlaws; and rules and regulations'of,the San Joaquin Local Health District. - .. - ----�------- ------------------------------------------------ By: t i --------- (Signed) (O er and/or Contractor) gY: V- #. -�._. �--- --------------- ----.--=(Title} - y (Plot plan, showing size of lot, location of systn in relation to wells,'buildings, a+c., can.b®.placed on reverse side}. ' i FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY -Kl/ ---------------------------=----------------- DATE = i REVIEWEDBY------------------------------------ ------------- --------------------- ------ DATE------------------ ..... -•-•---•---- BUILDINGPERMIT ISSUED--------------- --' ........ ----_--_---------------•-----------------'--------------------------- DATE----=---------------------------------------------------------- -rte:. .Alterations and/or recommendations-------------------------------------------_----------•-••--- ----------•------- -------------•-------------- -•--------•-------------•----------- -------------••-------------------•---•--------------------:-•------------- ------------------------• -------------------------------------------------------------------------------------------------------- f 1 f f x --- ----------------------•---------------------------------------------- -------------------------------- ------------------------------------------------- F_ --- -•--- - ------- -- -- i i ----------------------- -• - --- '---------=-- ------------------ ----------------------------------------- ----- ---- --V ---- V( I FINAL-INSPECTION-BY:- / .___--------------------- -------- --------- - Date--.- 7/n- ---------------------------------- 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 ti ES-9-2M Revised W-2100