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a APPLICATION FOR SANITATION PERMIT Permit No. .4 -p- ---7 (Complete in Duplicate) Date Issued ___. Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �J 1 JOB ADDRESS AN LOCATION------- -----134_Y----------------L_ 'Itt-Vii^-.L_ �r---- c�'_ �-- ------ - -------------------------- Owner's Name------ �i Phone Address............ ------ ---�---`---------- p r —'---- ------- ---------# ----------------------------- Contractor's Name -5, '} f-e' P k � 'F --�-L-----�'- p�e_ ---t3-- Phone7f* 1_ Installation will serve: Residence qq ❑ Apartment House ❑`` Commercial )K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l____ Number of bedrooms __-/_-. Number of baths Lot size ______________________-___._-_____________________.____ Water Supply: Public system ❑ Community system [Private ❑ Depth to Water Table Z_`? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'% Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ .I Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [9-' TYPE OF INSTALLATION AND SPECIFICATIONS: i i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �}l Septic Tank: Distance from nearest well---A_'e_Jbistance fro .foundation...1_4_�_.___-Material_____- rf--rrn:_c.i�_e__ j No. of compartments-------__7—---------Size------•----7&0:_Q_aj Liquid depth. ,T. .........:.. p Capacity . __._Ca acit i Dix[ Field: Distance from nearest well Distance from foundation_____ Distance to nearest lot line_ °""""_. Number of lines-----------------------------------Length of each line-----------------------------.Width of french---------------------:-------_----- Type of filter material-------------____-----_---Depth of filter material_________ ______.___rTotal length-----------------------------------____ Seepage Pit: Distance to nearest/ Il�lo.- �P._____Distance from fo ��fatl�n____._a'�.___. is a to nearest lot line____ . tF.K !I �f �? y� �l --F �D----.De th_...-:. 0 `r_ { Number of pits------=-- - L'raterwal:: 4-.------4--`-- S�ze:.Diameter - p = 7 I l Cesspool: Distance from nearest well_________________Distance from foundation_._._._.__._.._.._..Lining material_____.___---------------------------- ------------ 0 ______________.____________ ❑ ;� Size:. D:iameter------_-.�--- ---------- :_------_D-epth---= ; ::�: i ------- Liquid ,. r . Privy: Distance from nearest well--------------------------------------------------Distance from nearest building______________.___________._-_-__-,______- j ❑ Distance to nearest lot-line----------------z---------------------------------------------------- ----------------------------------- ------ IRemodeling and/or repairing idescribe7:------------------------------------------------------------------- ------------------------------------------------------------•------------------------- I ------------•----------•------------- - ---------------------------------------•-------------------•-------------------------------"----•--"--•--•------•----------------•------------------------------------------- -- - -------------- ----------------------•------------------------------------------•------------------------•-------•---------------------•--------------------------------------- I hereby certify that I have prepared this application 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. I~d. sp!e an Concrete Pipe Co. ---- - ------ (Signed)--------------------------- ------- ----- -----------... _ :-- _[Owner and/or Contractor) . ----------- Title (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY---- /' " ------I--------------------------------------------------------------------- DATE------ -1 rf -------- -REVIREVIEWED EWED BY--------------------------------------------------- --------------------------------------------------------------:--------- DATE---- ------- -- BUILDINGPERMITISSUED---------------------------------------------------------------------------------------------------- DATE--------------------------------------- Alterationsand/or recommendations:--------------------------------------- --------------------------------------------------------- ..........---...-----------------------•-•----- ----------------------------------------------------•---------------------------------------- -------------- -------- -----------------------•--------------•-•--•---•---------------•--------------------•-----------------•- I. ---------------------------------------------..----------------------------------------------------------------------------------------------------- ------------------------------_----------(-I-- --`h----. ------------------------ --------------------------- ------ ------------------- �-----•----------------------------------------------------------•-------------- ----•------------------------------ .FINAL INSPECTION BY: --------•---------------- ----------------- -- Date.--- ---- SAN JOAQUIN LOCAL HEALTH DIST T 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 - ' Revised W-2100