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Y APPLICATION FOR SANITATION PERMIT Permit No. o--- - 1 ►'�� li D i l (Compete n Duplicate) Date issue4:�t 3j-_�_'j- District for permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health This application is made in compliance •th County OrdinancTIE 49. JOB ADDRESS AND LOCATION... 1 ------- - '-�- ...1-- ss�� ,� /� O / -------- ---. Phone------------•----------------------- Owner's Name-------------- 7,7--4 A - - ---------------------_--- ` '�'_' - --�---- ---- ---------- ------------------------------------------=-------`--------•:-----'-' ---_----------------------- Address Contractor's Name--------------------------------------------- ---� --- -- ---; ------�� -,�-- InstaWion ;;ill Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo�tgel ❑u Other ❑ Number of living units:- --- Number of bedrooms -- --. Number of baths _ __ Lot size _, _+�6�_- ---/�-_.- - - --------------- _.. � .,o...q I Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tale ft. Oiaracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ sandy` Loam O' Clay Loam Clay ❑ Adobe Hardpan Q # • r Previus Application Made: Yes ❑ NoWT New Construction: Yeses 0% t L,YPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is availabie within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material----------------__..___..___-________----._-.__. o. of compartments--------------- • - _._.Size-----•-----------------------_.-Liquid depth.-------------------------Capacity------------------ ` # s f C Disposal Field:�' Distence�from nearest well________________Distance from foundation------------------_.Distance to nearest lot line________._____ Number of�i'inest. -------------------------Length of each line---------------------------- .Width of trench ir Ditance fo nearest well__-.-----_Dispance Total length----------------------------•--------- -- I Type oTr filter material---._ ___ Depth of R SeepagKe Pit: -.V---- 4 filter materia-n �i- Distance to nearest lot line_ m ,fo dation__ __-___ '� N umber of pits._Q1V45-- ._Lining'maw ial_ .Size: Diameter-- �---------Depth-So----- Cesspool: Distance from nearest well-----------------Distance from foundation--__..--------------Lining material------._.---------------------.______- �w S ze: Diame`t'er !-----------------De th- ---------�'a-----•----- ----------------- Liqufd Capacity gals wt �, 'Y, t a t a #�. li �_._ ----- ---- ----- Priv Distance rom nearest well_____________________ ...... _-.-- --Distance-from ealest�bu ldirig_ Wil' Distance to neares#'lot line'"". e = \�' T - ---------------------------------------------------------- ---- .,r --------- Remodeiing and/or repairing (descro4�el:-- ----- - ---- - -�- -- -------------------- ------------------ --- ----------- - - --- ----------- ----- - ---- a J -� I - •----------- ----- -------- ------- ------- - ------ -----------------------------------1�_..______..___ _ _ ,; __________ __________________ ________________________________ .__..________..______. ____ iI ____ ______________________________________________________________4�____._---^---__________.._-___-__..______---_____________------_-...----- ------------ ------------------------- -------- __________________________________________ ________ __ _______________________ I hereby certify th I ha e-prepared thW application and that +he work will be done in accordance with San Joaquin County ordinInces, State laws, nd r es and regulations of the San Joaquin Local Health District,,' I (Signed ! ==- - f:--.--- --=_-- Ownertand or o tractor) _4 1 ) �= - = - -- - ---- .!«. ,- B - �: a -(Title) --------- (Plot plan, showing size of lot, locati, n of system in relation to wells, btildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY ---- DATE----------- APPLICATION ACCEPTED BY---------------------- ---------- - �- REVIEWED BY - ._ ,—. ��1J --- ----------------------------- - -- - ....------._.a4.. `" ...�-._------ ---f' TE ---------- = -------------- BUILDING PERMIT ISSUED__k �_ �1 �� ----�D�ATE------- ----- ------------ ----- -- 1-t ,,r. , * :s.i i✓"L wr.i jam} ...... s-.. and/or recommeiida+Eons: -----------`-_" ---------- ----------------- -Alterations ..'...... ------------------- ------ •--------- ` -•------------------------ -------------•------------- ----•--------------------................ ---•-•----------------•------------------------------------• -------- ----------- -------------------------------------------- _ --.. - -- ------------ -- -------------------------------------- ---------------- -------- -- y--•------• ---------------•----------------------- - - - - U FINAL INSPECTION BY-------------- -- --------- - Date-------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streat 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 0-52 Revised W-2100 w +�