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APPLICATION FOR SANITATION PERMIT Permit No,41__________________ 7--------- (Complete in Duplicate) Date Issued ----------------- oe7— 0&0-62- Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install t e work her described. This application is made in compliance with County Ordinance No. 549. ir ff( -L f"t 1110mlf +V& JOB ADDRESS AND LOCATION_ 177e� _ - -------------------- ----------- ------ Owner's Name-------------- 4"�Ll------ ------ --------------------------- -------------------------------------- -- -- Address---------------------- --------------------------------------------------------------------------------------------- Contractor's Name------------ __6__ ev-_K1111--1 ----------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: 1 Residence Apartment House Commerc.4.6-1 ❑0 Trailer Court E] Motel El Other Fj UUNumber of living units: Y---- Number of bedrooms VN ber of baths J---- Lot size ------- - ------------- 1 1 41 Water Supply: Public system E]- Community system El 'Private �Depth to Water Table -------- ft, Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Lo Clay Loam 0 Clay dobeoldrfr Hardpan El E] Previous Application Made: Yes No New Construction: Yes ;PE] A NO El� fi TYPE OF INSTALLATION-AND,SPE61FICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distan it/_ �--_ Distance nearest well------VP ---Distance from foundation_"-- - -I--- --- Material--------N,--------------------- ---------- No. of compartments---------)_�--------------Si,e,z- --------Liquid depth--------------YA f------------Capacity-----S.�riq Disposal Field: Distance from nearest well-- from foundation 2D-----------Distance to nearest lot line-___5--------- --------------'Length of each line--------6q, Width of trench---------- Number o' lines---------------31- -----I---------- Type,of;filfer maferiaP..___ _W_._- ___Depth of filter.maferial------IS-------.,.--Total length-------- -k Seepage Pit: Distance to nearest well------------------ ---qisfance from foundation---- -------._....Distance to nearest lot line__.._.____.______ 4 El Number of pits----------------------Lining material-------------------------Size: Diameter-----------------------Depth--.--.------------------------.-- Cesspool: Distance,from nearest well_____________`_._Distance from foundation------------ -----..Lining material-------------------------------------- El Size: Diameter--------------------- ------------!---Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy-. Distance from nearest well--------------I----------------------------------Distance from nearest building-------------------------:�---------------- El Distance to nearest lot line-------- ---------------------------- ------------------------------------------------------------------------------------- ---------------- -------------------I-------------------------------------------------------- Remodeling arid/or repairing (describe):------------------------------------------------------------------------------ ------------------------------------------------------------- -------------- -------------------- ------------------------------------------------------------------------- ------------------- ------------------ --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------------r --------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- 1 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 thA Sin Joaquin Local Health District. (Signed)---------- --- ------------ --------------- --------------------------------------------------------------.--(Owner and/or Contractor) 4 41 - By:-- ----------------------------------:--------------------------------------------1-7-----------------------:--------------(Title)------------------------------------------- ---------------- - (plot plan, showing size of,lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------I----- ---------------------_------------ DATE-,------ ----------------------- REVIEWEDBY------------------------------------- ------- ------------------- ------------------------------------ DATE.'— --------------------I---------------------------------------- BUILDING PERMIT - DATE ISSUED-------- ---------------------------------------------- " ----------------------------------------------- -I------------------------------------------------------------ Alterations and/or i•ecommendations---------------------------- ---------•-----•-- --------------------------------------------;�------------------------------------------------- jF) ------------------------------------------------------------------------------------- -------------- jn .�A.4�ju 4eok-y --------------------------- ----------- .... .................... ----- --------------- -------- --- ----- - �M ------ .... . ---------------------- vp-------- - - FINAL INSPECTION BY:.. -------------------------------------- Date-- _'�--------C-7-------- -------------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Led!, California Manteca, California Tracy, California ES-9-2M io.52 Revised W-2100