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VAPPLICATION FOR. SANITATION PERMIT Permit No. �! (Complefe`en Duplicate) z Date Issued Applica+ion is hereby.made to fhe San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Count Ordinance No, 549. JOB ADDRESS AND LOCATION ___________________ __ _ -------------- -- � 7._A��------------------------------------------------- Owner's Name------------- — -------------- Ph .. ------'---'-- --------------------- Address- -------- --- -- ----- one Addresss.. = -------- --------------•-----------•----------------------------I--------------------------------- --- ------ Z 42 Contractor's ------- ---------------------- Contractor's Name--------- __ ` Installation will serve: ;Residen� Apartment House'0`Commercial`❑�Trail -Co urt F ❑ Motel ❑ Other ❑ Number of living units: -� !Number of bedrooms Number of baths Lot'size ----7-1 Wafer Supply:`Public system Community system ❑, 'Private ❑ , Depth'% Water Table4/_A_ ft. Character of soil to a depth of3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobei Hardpan ❑ Previous Application Made: Yes ❑ No gj� New Construction: Yes [ to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool pernr iffed if public sewer is available within 200 feet:) 3 4... ' 1 Septic Tank: Distance from nearest well_ 4 ' _Distance from foundation___ ______________.Material-_____._-"_____._ .---____. No. of compartments------�__ -_.__._._ Size !� IF ' y ----Liquid depth-----1/ Capacity.. S'-C� - ---- Disposal Field: Distance from nearest weiL� _�1Distance from f unda#ion-__t p'3_�.Distance to nearest lot line_ -_ , Number of'lines__I__:/.....:... :.... " -_-Len th of each line__ t - g �i __r3Q----.Width of trench.::._ _Y_ �.--- Type of;filter ma#erial_` =:/T- a----Depth of.filter-material, -/!�r''-----.Total length_-_l 3-IF- .......................` , ` `9F ' �, cam, .. . r - 0.� `yf" ,Z " V Seepage t: Distance to; nearest well _-�C, A`Distance/rom foundation____��-____ ",Distance to nearesf lot line-_._S Number of -- ----Lining materia------------•---- - -size: Diameter-=..---- -'-'- --�--r--- 'Depth--'---?_S--------`- -- Cesspool: Distance from nearest well-------------: `Distance from,:faunda#ion---_---- : __..Lining material______________________'_-. r ` ❑ Size: Diameter--- ------ ------ lDptO:`:--- "-----------------------------� lLi uid Ca acit _. ---•---- gals. Privy: Distance fr'.om nearest well_,____.- Distance from nearest building _ ----------------------------------------- ❑ Distance`to'nearest lot-line_ --_'" -------------------------------- ----------- �� .- -------------------- ------ ---------------- ------------------------ - r Remodeling and/or repairing (describe)_----------------------------------------------- =-- t i - _t -- - t- . - - .. -----------------------------------•----•--•-----------•- ---------------------------•----------------------------------- thereby certify fhat-l have prepared this application and,thaf theWwoA will be done in accordance with San Joaquin County ordinances, State laws, and .ules and regulations of he San Joaquin Local Health District. � Y n� � �J Y (Signed) ------------- ' ---- ---------- ----"------------------------------- -' ner`and/or Contractor) ��//JJ // k A BY� 4 � ,: ----------- - ------------------------ of - ----- - --[ -- - - -- --- ---. s [Plot plan, showing size lot, location ystem_in relation}`fo wells;buildings, etc., cacti be p aced on reverse side). J .FOR.DEPARTMENT,USE ONLY.4.,,,,,.4 I APPLICATION ACCEPTED BY--- = ---�r-56- - --------------- DATE.--------- ------------ ------------------- -- REVIEWED $Y'-- = -- ----- -- ------ DATE. BUILDING PERMIT ISSUED-----------------------•---------------------_- r -'--=------------...-----=-=-----------••----------- DATE-------"-------•----------- A ferations and/or.recommendations-------------------_--------------_--,....--------•-•---__- I I _-----------•--------------------------.---------------' - -- s -•--------•---------------•--------------------------- -------------------------------------------------------------- FINAL INSPECTION B - - - = ,!� -- ='-rpt :-- Date_ . .,--. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300,West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-210o L ,