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APPLICATION FOR SANITATION PERMIT Perritt No. 1-93 (Complete in Duplicate]-,� Date Issued -�� t Application is hereb a to the San Joa pin Local Health District for a permit to construct and install the work herein described. . :. This application is ma a .in compliance with o.unfy Ordinance o. �YTfi: .. - _-- Y _ -------------•----- JOB ADDRESS AND LOCATION-------- ---- :- ;2-- Q-/ ------ Owner's Name . Phone------ -----------------------------h Address-----_----------- ------- ------------------------------------ -------------- ----------------------------------------------------•------------------------------------------------------------- ` Phone---------------------------------- Contractor's Name_------------- •- - ;. ' ' --- ------------------ Installation will serve:A Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms A____ Number of baths __}____ Lot size ----------------�_��'_---�&'y'----------------- ---- Water Supply: Public system ❑ Community system ❑ Private.0 Depth to Water Table _90_ ft. . Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ Previous Application Made: Yes F] No E` New Construction: Yes V. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer rs available within 200 feet.) +`"- Septic Tank: Distance from nearest well-_____.rte______'-Diytance from#foundation___l__��_..____.Material_'i ._ _ _ _ No. of compartments_ - -Size x = . ---Liquid depth-----------�y Capacity �rt�� Disposal Field: Distance from nearest well from foundation---- U_...-__.Distanee tb nearest lot line_-___�____.-. i -------f---Length of each line-----�---��- --------Width,of tre ch----- -2-y---------------- n - ------ Number of lines_____________--_____-_ _ t material ==Total length Type of filter material___._______.-------- __Depth of filter, I I f-. f % Distance to nearest lot line_________________ Seepage Pit: Distance to nearest well-------------- _a,__.Distance from xfoundation_:..____ R.-_ _.__. ❑ Number, of pits---------------------Lining material_. ----------------Size: Diameter_ Depth t - Cesspool: Distance fromnearest well-----------------Distance from foundation__________----------Lining material--------------------.--------------- . Size: Diameter---------------------------- ---------Depth-----------------------•------- ---Liquid Capacity.-... _gals. Privy❑•. Distance frominearest well-----------------------------------------=-----_Drs a e;from nearest building-----------.--------------------------.. ' ---------------------------------- ❑ Distance to nearest lot line---------------------------------------------- ----- '- ---•--- - --------- � A rh, .I ' Remodeling and/or repairing (describe)----------------------- w -----------------------------'--- C ' ° - wx -fit--• Yea -------------- -----C_* ------------- ------------------------------ ------------------------- - -- --- -------------------------------------•- I hereby certify that I have prepared this application and that the work will beMon, in accordance with`San Joaquin County t. ordinances, State laws, d rules and regulations of the San Joaquin Local Health •` �' Si ned 2re 'S' (Owner and/or Contractor) ( 9 )- 4 - "-,{ - B •` ---- Yi----' _-� -`-- -------------- {Ti+Iep ------- �' (Plot plan. showing srze•of lot, location of system in relation to wells, buildings, etc., can be laced on r verse side):` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ----- s6------------------------------------- DATE------ ----- - - ---------[/ ��" - DATE--------------- ----- --- - -----•------------------- REV]EWED BY------------------------------------------- ------------ ---------- - -------------- ------------------------------- - BUILDINGPERMIT ISSUED-------_.• ------------------------------------------------------------------------------------------- DATE---------- ---------- ---- =' ------------ Alterations and/or recommendations----------------------- ------•--•------------•------ --------- -- •------. ------------- --- FINALINSPECTION BY----------- ----------------------------------------------------- Date--------------------------- ------------------------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street 300 West Oak Street 132 Sycamore Street 814N esti! "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 ES-9-2M 10-52 Revised W-2100 '