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`Ate :r• _� - � ... T ,� .� f� APPLICATION FOR SANITATION PERMIT a O Perm;t-No.,� is ------------------ , \ c(Compjgfe n Duplicate} '+7� Date Issues! 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,0r inance No. 549. JOB ADDRESS AND LOCATfON___?'Y�_EOPs- Owner's Name-Mint--------------Pie- _ao--------------------------- ----�- --------------- ------------- ------------------------------------------ -----N, , .. r S. "� -�^ .E,__W1,/1 E�.�Y4 p ---------------------"'• Contractor s Name___ Q 3-_."" '�,k -------------------- �� a---- --------- --'I�l_S�3.M-------------------- Phone - ' ------------------------ Installation will,serve: Residence X Apartment House ❑ ,Commercial + , ❑ Trailer'? ❑ Motel ❑ Other ❑ Number of living units: _, Number of bedrooms �_ Number of baths 3 f" � , ____ .Lot size ___ Wafer Supply: Public s stem `` " �"" ----------------"`- PP Y� y ❑ Community system ❑ Private 9 Depth to Water Table _3V ft. Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑.Clay_[1_Adobe 04 Hardpan E] Previous Application Made: Yes ❑ No X New Construction: Ye,5g No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) i Sept Ta Distance from nearest well-__ �- 1 P �_"-- Distance from foundation__",(-�--- "-----.Mat�rial__-___"_- _-- No..of compartments Size_ -------- Disposal 4 X" _ ---- Liquid depth------ -- ��Disposal Fields Distance from nearest well--- Distance from foundation___,�df _ �/ � �: I Distance to nearest lot line----V________. Number of lines---._2------------------------Length of each Iine_cIOj""40 .l/O1 Width of trench._"__z. "'1 - r x 4 7 3 " -- rIN Type of filter mateiial_,5�T_R,._k__Depth of filter material-__ .15 __--_"-__"" 4 Total 6ngth_"____"'2_:rfD ' p� -- ------------------------ Seepage Pit: Distance to nearest well-_____________________Distance from foundation-____ �w Number Distance to nearest lot line______.________ ❑ Number of pits---------------- ""--Lining material-_.------ "" --`---.-Size: Diameter...-------------------- esspool- Disfanco from nearest well _...____Distance from foundation"___-----------' Lining material "_____""-__ ----------- --� Size: Diameter-- ------------------------------------Depth-------------------------------- - ------- - - -- -- Liquid Capacit -----------------------------gals. •'Privy: Distance from nearest well-------------- from nearest buildin g . ❑ Distance to nearest-lot line_____________________ _. .—. - ------------------ Remodeling and/or repairing (describe}___________________" f ---------------------- :--------------------------------- 1 •---- _________________________ ---------------------------------- 1 .____..--------•------•------'--------'------------------'--^----------..---••-----•---•---- ----•-. --------------------•----------�----------•-- __- : I hereby certify fha+ I have prepared this application and that the work will be done-in accordance wi+h San Joaquin ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. County (Signed)_. r ------------------------------------------• r an BY:------------- l Title r Contractor) ' ------ ---- e o (Plot plan, showing size of lot location of system in relation to wells, buildings, etc., can be placed on reverse side). j ?� FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY__" REVIEWED BY -- "" t A-=------------------- DATE � � ,��------- - -- 1 ------------------------- ------ ------------------------------ DATE---------•-------------------- -• - ---- UILb.ING PERMIT ISSUED ------ ------------------ ----------- "' DATE----- ------------•--,-------------------------------- �.i A ferations and/or recommendafians:______--___"_._.._.___ ._-__"_ ----------------- �.,., --,-- j1` LL � I - ----- ---- ----------- P� e t5 - P -------------------------------- --- ----- - FINAL INSPECTION BY:_""___ / .- � . ---------------------------------- Date �---------1 ---------��--- -�---------------------- = _ N JOAQUIN LOCAL HEALTH DISTRICT f30 South American Stree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9--2M ; - Revised W-2100