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APPLICATION FOR SANITATION PERMIT Permit No. �a_ __� •_ "�• _ _ y (Complete in Duplicate) r - Date Issued ------ Application ---_, �A 1' ation is l D( 070-7 pp hereby made to the San Joaquin Local Health Disfdct,for a perm'r#lto construct and install th work herein'described. /\This application is made in compliance with County Ordinance No.'549 0, JOB ADDRESS AND LOCATION__._---�-- Owner's Name I �~ -rte-[=Cum ------- ---- --- --------- Phone_ 4 -i _y_.. Address-------- - , tr + {, w Contractor's Name--- .. fi r - ---------------- Phon e Installation will serve: Residence Apartment House Commercial . ❑ Trailer Court[]-,.Motel ❑ Other ❑ Number of living units' �.. :� -__ j ��Numb'er of bedroomt ' s..,____—Number of baths J--- Lot size _- - - ---------------------- Water SuPPI • Publics stem ` Commuriity system ❑ Private _Depth toWater^Table- _ 'l . a�� Character of soil to a depth of 3 feefi—" and-❑f Gravel ❑ Sb ndy Loam jg Clay Loam ❑ Clay' El: Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No M New Construction: Yes ❑ No ® FICA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 fe t.) � N. f Septic Tank/ Distance from nearest well______ __________Distance from found _ation__.--- _--_-_---_ Material_----__-_-_-_ -------_-------_-----__--.__--_---. No. of compartments-..----------- ----------Size--------------------------------Liquid depth.------------i Capacity -------------------- Disposal Fie d: Distance from nearest well._------- o nearest lot line_---__-- Number of lines-------------------- --------------Length `of each line------------------------------Width of frenchC ---------------------------- - Type of filter material_----_______Depth of filter.material----_ Total—lengrth------)-----________________ /, r6 Seepage Pit: Distance to nearest well-- l-ar !Distance from .f `undaficn-I� Distance to nearest lot lineAy" ---I� Number of pits--------I------------Lining material_.• -��__..5ize:. [3iameter__..3,3-----------Depth---��] ------------------- Cesspool: Distance from nearest well-----------------Distance from fbur'd-atro_i'_'----------__- ..Lining material-I--___-_____- - ❑ --------------------- Size: Diameter -- -------------Depth----------------------------------1�,,,-:- #= Liquid Capacity) gals. Privy:', Distance from nearest well------------------------ -- -- --------------------Distance from nearest building------1--------,--_--------_- - ❑ Distance to nearest lot fire - p ; I - --------------------------------------------------------------------------------- + Remodeling and/or repairing (describe):-------- t_ �i�_F- j3j��( a ': ! -------------------=------ ---•---------------••----------------------------------- 1 l ---------------------------------------------------------------------- -------------------------------------------- p PP yr i I ---------- -- ----- ------ -- -- ------ -- I hereby certify that I have pre ared this a lication and that the work will be done in accordance with San'<Joaquin County ordinances, State laws and rules and regulations of the San Joaquin Local Health District, 1 r ' (Signed)-------`�`'------------ -�-`�-'--------- - - _ � ✓ _ _ _ _ _ (Owner and/or Contractor) - {Title) � z ' ' �'1' -------------- `. (Piot plan, s owing sizaf lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 5`11 APPLICATION ACCEPTED BY___________________ - „ .. - DATE REVIEWED BY ..,�[„' DA 'E -_-�X- - -------------------------- f BUILDING PERMIT ISSUED ... -----------------( DATE Alterations and/or recommendations--------------------------------------_0_ l { ------•--------------------•------------------------ 4 ------------------------------------.._--.--_._ FIN L�INSPECTION�BY:. = `f _ . .�. .,.... .. Date /( SAN JOAQUIIN��LOCAL HEALTH�DISTRICT + ,� 130 South American t- treat 300 West Oak Street 132 Sycamore Street Bid North "C” Street Stockton, California` , - Lodi, Cal fi orniaf \d ' t:Mantec', + California \,L Tracy, Califorhia ES-9-2M , Revised 1,57 F,P,CO. �.