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APPLICATION -,FOR SANITATION PERMIT P 3 Permit No. .��7_37 �,O(Complete (Complete in Duplicate) A � � J `* 1 A Date Issued _ SL I•' •�,� .sa. #.; ( Application i� i ereby made to the San Joaquin Local Health District for a permit to construct end install the work herein described. This application Is made in compliance with County Ordinance No. 549. � y A 4_w JOB ADDRESS AND LOCATION----------------#0_�3 r 3J /4 „ 1 , --- ---------------------------- s Owner's Name-------- ------------ -� -------------------------------------- . ----------------------------------------------------------- Phone-----------•------------------------ � Address---------•------------------------•------------F-----------• -= - S -------------------------- Contractor's Name___________________ __ "" Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ------ ------------- ---------- Phone-------- --------------•------ ---- ❑ Motel ❑ Other_❑ Number'of living units: -------- Number of bedrooms --" -- Number of baths --it-__-- Lot size -- """--��-1 �s'_ .Water Supply: Publics stem ----- """" -- -------------- y Community system C❑ Privatex Depth to Water Table -------- ft.- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 64 Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes k] No ❑ �1 - f TYPE OF INSTALLATION AND SPECIFICATIONS: Zst (No septic tank or cesspool pe'rmi#ed if public sewer is available within 200 feet.) J^ P _. "y -Septic Tank- Distance from nearest well _____""Distance from foundation______" ! Material_ { ❑ x(15 No. of compartments--------------- ----------Size------_" Liquid depth ---------------Capacity-=---- ------ W Dis�sal field: Distance from nearest well _ f i 70----Distance from foundation------_74-------- Distance to nearest lot line____._-~------ Number of lines__________________"_ -"-" Len th of each line______W3x _ <"jD"__1Nidth of trench________ ' Type of filter material.__.__ ci " g ry ` -,W - _---_Depth of filter material_______ _ length ---Total -------- Z---,6----------- Seepage Pit: Distance to nearest well________________ ______Distance from foundation--------------------Distance to nearest loft line___________"____. ❑ Number of pits-----------------------Lining material-- ---------------------Size: Diameter------------------------Depth------------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________________ [� ❑ Size: Diameter------------------------ -------Depth-------------------------------------------------- --- - Liquid Capacity----- ----------------- -gals. Privy: Distance from nearest well-------------------------"-_----- - Distance from nearest'buildin .ElDistance to nearest lot line--- "-- g ----------- - --------------------; --- ---- ---- - ---------------- Remodeling and/or repairing (describe)--------------------------P j -- - --- , 1 Pte--- - -----•-- - ------------------------------- ------------- -------------------------------------------- ------------------------------------------ -----•- ----------------------------•------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the woSk,,wwill be done in accordance with San Joaquin County ordinances, Sta la , and rul and regulations f he San Joaquin Local-Healfh District. (Signed)---------- --- ------ ------------ -------- - ----- -- --------------------------------------------------------------------------- ----------(o caner and/or Contractor) gy: ----------- --------- Title ---------•------ -------------- -------------=---------------------------- - ------------------------------------------------ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY ---------- APPLICATION ACCEPTED.BY________________"-.__--.-__" ---------------------------------------- WDATE-- "" REVIEWED BY- ----------------------------- -------- - - S -✓�-�------•=:----•------------ DATE . ---- ---- . BUILDING PERMIT ISSUED _ __ ' ---- --------------------- - ------ DATE---------------------- - ------------------------------ terafions and/or recommendations �-�._>" _"-"_ --------- -- -------------------- -------------------------------------------- ------------------------------------------------------------ .--------------------------------------------------------•-------------------------- ------------------------------------------------•- ---------- --- j------1------ - --------- ----- ------ -- -=--'------------- FINAL INSPECTION BYi_____-""_.-"-- --- Date----- -"-- -------- ---------- - -- =- ----- ,. . -- ----------------------------- ------- SAN --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S}reet 306 West Oak Street 132 SycamaFe Scree} $14 North "C" Street Stockton, California Lodi, California Man}aea, California Tracy, California ES-9-2M 8-51 Revised W-21DO