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f � APPLICATION FOR SANITATION PERMIT Permit No.c-W-��7x_- -_ q 1 (Complete in Duplicate) � I bate Issued ��-_'�_��•-- �pplication is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein described. a' This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI l`_.11_..-- Owner's 'Name ---------------- -6-73 -- --------- -- r - ---- -----Address :3.3 - --- -------- --------- ----------------------------------------- Phone .� '3 --------- Contractor's -----on rector s Name................... ---------------------------------------------------------------- - ---------------------------- --------------- ------- -- ---- --__-_-_ --------------- Phone--------------•-------------------- Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: �_- Number of bedrooms _;Z-- Number of baths _ -- Lot size ---_-.4 4PX-/_X ------------ _0 Water Supply: Publicsystem i Community system ❑ Private E] Depth to Water Table -------- f+. {� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ 111 Previous Application Made: Yes E] , No rV New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic-Tank: Distance from nearest well__- is ance from foundation.---- `Fey No. of compartments--------2----- a Mate iaf--------------------------------- Size f -e_15---Liquid depth------7 M Disposal Field; Distance from nearest welh.:_-..__---__. ---------Capacity...,/_46eZIV istance from foundation.._ -C�__-_Distance to nearest lot Number of fines------------------ ' - --- Length of each line------60------- -_d W,dth of trench------ - ------------------- Seepage ---- Type of filter material-__ -Y -.. --.Depth of filter material--------- - -----To+al longth._ - ++ Seepage Pit: Distance to nearest well-----..__._____._____Distance from foundation--------- ----------.Distance to nearest lot 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 building Distance to nearest lot line---... -- g------------------------------------- 0 --- -- ------------------------------------ - ---------- Remodelin /or repairing des ibe repair - r -- - _ - -------- [°. -------------- - ------------------------------------------A ---------------------------------------------------- I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------g=jr—_ - --------------------------------------------------------------(Owner and/or Contractor) By:---------------- -------------------------------------------------- ----------(Title)------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.............t___ -------------------- ------------------------- DATE REVIEWED BY € - ------------- -------------- '�-------------------------- DATE BUILDING PERMIT ISSUED . ' ----------------------------------------------------------- - - -- Alterations and/or recommendations:............. - wDT -__ 7� _--- - ., r - -------- ----------- --------------- - ., � ---- ' ------------------------------------- - ------------------- ----------- (------------------ -- _ -....__iir'Z.--l'- ------------- on, ----- --- --------------------- FINAL - FINAL INSPECTION BY:--------- -------- s --------------------------------------- Date----------•------ - -------------------- t 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 8-51 Revised W-2100