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APPLICATION FOR SANITATION PERMIT Perm " , (Complete in Duplicated 1Q .. Date Issued ..:......4.. Applica�ion is hereby made;to the San Joaquin Local Heal District for a permit to construct and install the work herein descf � ti) This applicction is made incompliance with County Or, o No. 5 9. ' - " ;�,g II� CY ------------------ JOBx' ADDRESS AND L CAT N..... ---- •............ .... . -----•-.... ----... ....................................... f F Pho e ..... Owners Name....... .. . n ........ Xx�� Address_ E#` .,, y 4� ....... Phone ... Contractor's Name . ------ ....... Installation JJyf,�� f... _ Installation will serve: ReJ ante k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ R � 'I G' �.. ... �................. Number of living uni'ts:,�.__.. Number of bedrooms ..�.'. Number of baths .............. Ar .�.. Lot . � 9..... ! Water Supply: Public system E�L_Community system ❑ private ❑ Depth to Water Table 4pd- ft. Character of soil to a dep fM of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobepL_Hardp Previous Application Made: Yes ❑ No ❑ New Construction: Yes ;jg- No ❑ '�" TYPE OF INSTALLATION!IAND SPECIFICATIONS: � + (No septic tank or cesspool permittedif public sewer is available within 200 feet.) y II. i . : Septic Tank: ;Distance from nearest well-................Distance from foundation--------------------Material-------------------.-.--.---_-__----_--- .y ❑ �� of-compartmentsSize__... .... Liquid depth..........................Capacity............ .. +~ Disposal Field: istanC!6 from nearest well --- Distance from foundation....................Distance to nearest lot ❑ . �AJumber of lines_... ---- -----Length of each line------------------------------Width of trench----•------ .....----...lrf ` ype I�i& ...filter materia{.... ....�...f,....-.....Depth of filter mnteriaL....:..��..P--..-To+al longth................................��•pl Seepage Pit: Distance to nearest well---._ ]GQ efaanc a fro fou +�nDiameter_...�a,�..�oDenearest lot line__ Number of pts----- -------------Lining Cesspool: Distance from nearest will-----------------Distance from foundation....-....__.........Lining material............................. a ❑ Size: Diameter------ ....................... .....Depth......................•----- ---- -................Liquid Capacity....--------- ti s I Distance from nearest building Privy: t Distance yrom nearest well. g.-.- --- *, ❑ D�starice to nearest lot line.._........ --------__ ------•-----------------•------•--•--..._..--------•--•--------------- Remodeling and/or repaiing (describe);---- -------------------------- ------------------------------------------------------................................................... ......-..... .... ........................ . ... ...•-------------..---......------•-----._.. . ................................. ...-------•-•............ ........•----------•---- -------• I ;.. r1 i 1 I1, -------------...............................•--------•-----•-------------------•-----••-•-------------...._....--•-- • - I hereby certify tha+��) have prepared this application and that the work will be done in accordance with San Joaquin Co' ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. (Signed)....-- •-i�--------•--•-----�• ----- •-------- --- ------------------------------------------- ner and/or Contra# r� -(O (Title)_:.... � 1.'�.................... By:---- • T J- z� (Plot plan, showing size of lot, location of system in relation to we115, buildings, etc., can be placed on reverse side). {� I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........................... .... DATE..-....-� ._. I[ DATE................. �., REVIEWEDBY_--------------- ...........-- ----•-.............. _..................I.............-•-------._.... � #.. I BUILDING PERMIT ISSUED........................•---. DATE......._.............. ...................._... :) ..... Alterations and/or recommendations . ................. .......................•---------•---••----• .......\ ..........................................!M...---• .... ............... .. . .. ... . .. ... . .: ............................................................ ............I.......... .. -- �. "} II ................................................................................................................................. .. Date...... .._( !- / / �"' �---------_--•------------ FINAL INSPECTION BY:.. .... - •-• y,.�....................... .... f ------------- -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Streof 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cali{ornial`IIII Lodi, California Manteca, California Tracy, Celifornle I E 5-9 1-446 :..Y W O D O l!i -