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APPLICATION FOR SANITATION ` Nc 1 N PERMIT Permit No � _ (` ! (Complete in Duplicate) { Date,Issued /3" --,�_ Application is hereby m uin Lo de to the San Joa q cal Health District for a permit to constructed install the work herein described. This application is madi3lin compliance with County Ordinance .o. 54 . JOB ADDRESS AND LOCATION_.._ r -i ------------ - --•---- Owner's Namo--------� -- ------------------•- -------------------------------- ----------------------------------- ----------- --------- Address - Phones._. . � ---------------•--- --------�-------•-- Contractor's Name._. .-_-! --- �+•-,••t�'L.,,—�.-�.=.: _"-- qq --------------------- :�-�, e--------- Phone__1- �� -------_ � -------- Installation will serve: Residence ` �---""""""-""" -----` ` ©-Apartment House ❑ ~Commercial ❑ Trailer Curt ❑ M�el Other ❑ Number of living units: __/)- Number of bedrooms - Number of baths !�' a Lo+ size __ �.3D Water Supply: Public system [�Communi+ system # Y Y ❑ Private ❑ Depth to�Water Table Character of soil to a depth of 3 fee+�r"Sand 1,y❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe—Hardpan ❑ Previous Application Made: Yes l� No ❑ New Construction: Yes Loam ❑ TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic tankor cesspool permitted if pupblic sewer is available within 200 feet.) t Septic Tank: Distance from nearest well- _0-�-_-Distance from foo undation___.._ 031" �Q--- _fiMateri�l�_4_.�, N A of Rompwa'rtments--=------__ �__ -- Size_ .-<,` _-- " rr Liquid deptli-----a Cj---- Ca aci Disposal Field: DlsRance frominearest well ___.k`��ry"" Q umbepe r�fiiter material/ ---Length from foundetio�a {___-Distance to nearest lot line____�Q____\ Lep th of each line-------- 7_--.Width of trench----/-/ -- -��- ---De th of filter material---.--- !!`` Total length_._.___d G"-:-- !____ Distance from founciation___.7- - Seepa�Prt: I}IStdRCe to nearest well7- 'Q-�"' - ' 1 p t 1 4 r Distance to nearest lot line_� ..........❑ Number of its------_--1-------_ --Lining material__ ._:-- Si'* F ze: Diamet t Depth s�� --- Cesspool: Dlfa ce from nearest well-----------------Distance from foundation.__._._...____,.-----Lining material__ ----------------- - ❑ Size: `Q,IiXfer--------------------------------------Depth------------------------------------------- - -1=---Li uid Capacity IIq P Y -------------- -----gals. Privy: Disfanq:from nearest well------------------ ----- -- �;,� 4 _.______._-_"Distance from nearest building------------------------------------------ Distance to•nearest lot line____ __._____-____.____.________"*___--- I , \ -------------------------------------------------------- -------------- Remodeling and/or repairinglfdes�ribe):__nsr_---___.____ ! °�� =: -----------------------------=y�" 1 -------- ------- _k ------------------------------------------------------------ ---f---- -------------------------------------- ----------- ......------------------------- -- hereb certify that I have `� k = 1 -----------•-------------------------------- -------------- Y Y prepared this ap Lica+ibn and +ha+ the'work will be done-in accordance with San Joaquin County ordinances, S+a# laws, andrules and regula+ions``o"f�the San Joa uin Local Health District. �.,1 (Signed)__---- ----------------------� - ---------L ---!--------------- - n Contractor) BY:------------ -- ----= , .� _. - `----------------------------------------- and/or rr a o (Title)---- i - (Plot plan, showing sizeoftlof, Iota+ion of system in relation to wells, buildings, etc., can b' placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-- _ _----�;-- --_•.-.--_ " " l I �, -; ---------------- --------- ------------i DATE,- ----------------- BUILDING PERMIT ISS(1ED 1`` --l------------ ------ DATE-- REVIEWED BY---------------•-�,,3----_--- � _ "'---------j-------------- DATE.-- - Al+erasions and/or recommendations: 11 s ----------------------------- -- -- ------------- # - ----------------------i------••-------------------------•--------•----------•------------- -------------------------------••-----------"------•--------•--- t --I ------ ----------------------- ------------------ -------------- ------------•-+---------------- ------ f ----- --- - ---- --------------------------------- - FINAL INSPECTION BY;.-------- Date. --- : - f -- ------------ -------------- 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 10-52 Revised W-2100