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• APPLICATION FOR SANITATION PERMIT Permit No. .�.. (Complete in Duplicate) Date Issued /2._ r ..._! . 7'. S. 44"y 4 6+NLoJt4. 33 2SS-3r a� Appllca#ion is hereby made +o the San Jdaquin Local Health District for a permit to construct n work hereinescnbed. This pplication e in rsk J068ADNemSe_1ANDdLOCATIONnCe_wit .County r�ina�G�LA Phone 0 Owner's fd3a/ PP�r !/..•p.Sa rF . -•Jt�' ..---. ---- _... - - _..... -_...._... Address--------'---- - -- - --.. .__..- .. ................. .. Contractor's Name. -..........-...........- ..............---................ •-•- ......---------------------- - - Phone. ........ _ __ _-- Installation will some: Residence Apartment House [j Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑yy Number of living units: .1_-- Number of bedrooms .:1. Number of baths __1.... Lot, i � 4z;; .y,.i�. Water Supply: Public system ❑ Community system ❑ PrivateAr Depth to Wa er able -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay 4 Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Y New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public I wer is available within 200 feet.) Septic Tank: Distance from nearest well.--I&A--..Distance from foundation---.«---------.Material--- . 'I`jd1 No. of compartments......�1...........Size...... _ S�f.g Liquid depth....-/f-.................Capacity--- ---0_LZ_..... Disposal Field: Distance from nearest well.JQ-.6...Distance from foundation....l_fl.......Distance to nearest lot lin _4.i_.�... Number of lines.....____....�.,.y�.�^^--'' -._.. Length of each line...If. 40. __ ..Width of french...r .11=0 .._.....--_.._. Type of filter material----- 7_L.. pepth of filter material._.... tal length___--1_: ____..____...._... Seepage Pit: Distance to nearest well..................-...Distance from foundation..............._.Distance to nearest lot line...... ❑ Number of pits....................-Lining material.....................Size: Diameter_.................-----Depth....................--__-..._ Cesspool: Distance from nearest well-----------------Distance from foundation_...................Lining material.............................._..... ❑ Size: Diameter..........-...............___----Depth........................._------------------------Liquid Capacity.........._.........._..gals. Privy: Distance from nearest well---------___............................Distance from nearest building----------------._................ ❑ Distance to nearest lot line_..............................—__._..._.-.-.-__.-__-___......_.....__........-_._........._......_...._...._...._-._ Remodeling and/or repairing (describe):__...____...........-------------------............-------------_....._ - ------------- --------------------------------------------------------------------------------------------------------------------------------.....................--........_-............................. -- --------------------� ----...-........... .....-------PP----------------------............................... --------------- -------------.....---------------.....-q------------ I hereby i that 1 have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State Iews, and rules and regulations of the San Joaquin Local Health District. ................. - ---------------------------------......__-------- - ---------------- Owner and (Signed)--�-�.................... •------- � ---- - - ( /or Contractor) By:.. .tr` - ..-----'------.....__�:..------.--....._.....__._t.._(Ttle) - ..... '.................................. (%ot plan, ihowin-- safe of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - - ------- --------- - - -..}_......_.._._... - -- DATE.- - �'�� REVIEWED BY----------------_...---- --- - -- -- 1r4 ------------- DATE--..---r pl�gyp----•------ --- --------------- REVIEWED PERMIT ISSUED.................... ............. DATE- - - - �..7.._._..__._f Alterations and/or recommendation:...... Z r...�. _ .l'.Y....... ...............---------------------------- ----------- -------- ----lL�stef-Gs.at.�--- _ ._... - - �[ .._ _ ...._..Y......_.._.............-................. tY --- - ----- ---- - _..........._.........._.-._................'PAI�r ---- '--- --------- ---- �-- -nye-/ -": ----•-------------------•---- FINAL INSPECTION BY--------- ------- ---- ------ --- Date........... .;Z44.SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sooth American Sheet 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100