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71 00 cf APPLICATION FOR SANITATION PERMIT Permit No. __ ..........__--- _ (Complete in Duplicate) I Date Issued ----- 45__- Application is hereby made to the San Joaquin Local Hea€th District for a per it to conrl�sr ct act and install t work herein described. This application is made in compliance with County Ordinan cg No. 549. E JOB ADDRESS LOCATI N------------� --------- ------- r --~ Owner's Nam = •2 " `' r C !1? •f' i -� .. qxd Address = _� - ---------...__. r - - " Contractor's Name_._ _ 1__�-_ Phone__.-i` i Installation will server Residence Apartment House ❑ Commercial ❑ Trail CourA otel her ❑ Number of living units: __. -__ Number of bedrooms.e?— Number of baths —-__ Lot size _- i I . / I Water Supply: Public system El' Community system ElPrivat� Depth to Wafer TableC�4t. Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Hardpan ❑ Previous Applica+ion Made: Yes ❑ Na, Newons C +ruction: Yes ' No ElIw TYPE-OF-INSTALLATION AND SPECIFICATIONS: ll (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dis+ante from nearest well :____pis+ance�from flu dafipn_____ _---------Matgria__ -��------- ____ - ---"7� No. of com a rtmenfs_.__.':__ _ 11 Liquid de th__. ' p --- ;-- 5ize_�s� . � :----- q ----P. �---- - � Capacity-...- - -� ---Q- Disposal Field: Distance from nearest well_�lj___._DisfAce from foundation____...........Distance to nearest lot line---------- Number of lines---.-/---------------------Z- --Length of each line---'- C . - -------.--Wid#h of french------,��`�-------- -------•--� Type or filter material ____:Depth of filter material__ _ ------------Total length-------� �________________________� - See age Pit: Distance to nearest well__ _. _ff_`�_____Distan�+e om foundation___ __ __ Dista'?ie-e to nearest line----- __ Number of pits-----�"""------------Linr 'feria): -, --Size:' Dia __. .-------�eptn--- ----_------�^� Cesspool: Distance from nearest wall_________________Distance from foundation.._._._.___________.Lining mater-sal______________.____________.__--_.___. ' ❑ ,ti... Size Diameter---------------------------- ------Depth----------- .---------------------1------ ----Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest;well______________._---_----__._____---..___-_-____._Distance from nearest building.__._.____________________________.._-_ ❑ Distance to nearest lot line----------------------- �--------------------------------------------- ---------------------------------------------------------- ---- Remodeling and/or repairing (describe):,-_ 4--- ----------------------- --------------------------------- -----------------------------------------------------•------------------- ------•--------------"----•----------------------------------=-------•--- •--------------------------------------------------------------------------------------------------------- ------------------------------------- -- -------------------------------•--------------------------------------------------------.-.-------- ..........-------------------------------------------------•---•--------------------••-•------------------------------- ----------------------------------------------•----------•-•--"--------•--------------------------------•-•--------------------------------------------------------------------------------------------------- -------------- 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 an regulations of the'San Joaquin Local Health District. (Signed]- fJ ! ----------------------------------- (Owner-and/or Contractor) �//�}, I ---------- By:_----------- �. .�.•F�i.•'•. - +- - - - - - -----'---____(Ti+IBI..y.---- --G '{----v-- rl�'!,/_ ---------.... y:- --- ---. -- --• • � (Plot plan, showing size cf ot, location of system in relation to wells, buildings, etc., can be plat d on reverse k - ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- --- DATE----= ------ - j - REVIEWEDBY---------------------------------------------------------------'-------------------------------------------------------------- DATE---------------------------------•-• --------------- BUILDING PERMIT ISSUED---------------------------------------------------------------- ------------------------------------- DATE------------------ ----------------------------------- Alterations and/or recomm .ndatians:- f' l---�.. -� - _-------------- -------------------------------------- --------------------------- ------ --------- ---------------- ---- ------ ---- y� F // ! _ J A • �J.-tfr/tfj� FINAL INSPECTION BY::------ _, x.------------------------- Date--------- }��----------------------------- 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-4-2M 10-52 Revised W-2100 ;�`f