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APPLICATION FOR SANITATION PERMIT Permit No.4 .-- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein This application is made in compliance with County Ordinance No. 549. described. JOB ADDRESS AND LOCATION.-;---- - ••------��Y' '�- 9''� ------------(9!5-47)---------------lot-_-qo----91� f Owner's Name---------------Tr ------------------------- -- ---- Phone------3�ly,S--.--== ress --------------------------- ------!��3�------- 1 V_Y� '' � --.------ Contractor's Name___ -------••---•------------------------------•----- ----•-------•-------•------------------------ C?�4e1 . � -------------------------------------------------------------- --------- Installation will serve: Residence Apartment House ❑ Commercial - -_.__M Phone_ ❑ Trailer Court F] Motel ❑ Other ❑ Number of living units: _-� Number of bedrooms _.Z _._ ___ Number of baths ---L_ Lot size - l,.Q_ Water Supply: Public system ❑ Communitysystem ------------ Y ❑ Pr'ivate� Depth to Water Table _ys ft. Character of soil to a depth of 3 fee'+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Laama Previous Application Made: Yes ❑ ClY [I Adobe Hardpan ❑ ❑ . No �' New Construction: Yes ( 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:____ p¢_ Distance from foundation__._- n )�----------.Materialu, � No. of compartments__.-----_- --------------- :Size - X S--------Liquid depth-------- 2.... ------ Ca acit p Y -- Disposal Field: Distance from nearest weil___,�0�--.-.Distance from foundation_____ _ ___________Distance to nearest lot line__---�{------. Number of fines--'--.----•---- ----------------Length of each line-------11-0'_ Width of trench.----- --- w" Type of filter material-----1 •i -------------------� -- Depth of filter material-______l _--__---_-Total length__________-i-�o ____________ ___ _\ Seepage Pit: Distance to,nearest well______________________Distance from foundation__ v Number -_________-.Distance to nearest lot line----------------- -----------------------Number of pits---- ------------- ---Lining material__-__-_-- - , ------------Size: Diameter----------------------Depth------------------ Cesspool: Distance from nearest well_______________ -Distance from foundation--------------------Lining material_____--.----�----_ ElSize: Diameter----- ------Depth Liquid Capacity- ------- ------------- Privy. Distance from nearest vrell________----_------_' --------Distance from nearest buildin Distance to nearest lot line--------------- ------ - - g ------------ ------------------------------ --------- --------------------------------------------------------------i Remodeling and/or repairing describe)------ ____----------- •--------••--------------- ---------------------------------• ---''�--------- 4ut) �`f� '�_-�--- - ------------------•--------------------------------- --- -----------------------•--------•-------------------------------------------------------------------------------------------------•-------- ---------------------- -'---•----`--------------------------------------------------------------------------------------------- -------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rulnd regulations of the San Joaquin Local Health District. I (Signed)__-- -_ 13 ---------------------------------(Owner and/or Contractor) -.....---•--------•-------------------- -------- -------- ------------------•----------------- -- (Title)----------------------------------plan, showing size of lot, location of system in rela+ion to wells, buiEdings, etc., can be placed on reverse side). - ----- ------------------------ FOR DEPARTMENT 115E ONLY APPLICATION ACCEPTED BY __________--._---__--__ REVIEWED BY DATE-------- ------ -----..- �.� , --- --- -------- ------------ ---- --------- --- - ---- -------- - DATE---- _ -- ------•---------------------- Alterations BUILDING PERMIT ISSUED----------------------- ------- - DATE----------------- and/or recommendations:-______. ........................................ ---------------------- ---------------------- --------- ----------------------------------------------- ------------------------------------------------------------------------------ ------------ ------------------------------------ -- --- - - - -- --------------------- /x FINAL INSPECTION BY:......... / ; Dale__. T/ --------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ , 814 North "C` Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100