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Permit No. 2414-'� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued r Application is hereby made to the San Joaquin Loca4 Health District a permit to construct 1�install w�O� herein described. Thisapplication is.made in compI.- with County �'';] ! 30 ( f E�4—D i.Jr!s— C,e� JOADDRESS AND LOCATIO '_V---Ccl '�' Phone-- .�-�-�-�`-��-- ------- Owner's Name_'------------------------- R __ -•--'1�-dift--------------------------------------------- --------------- �_jk -_ Address-------•--•--- -------••------•--------- Phone_. Q ----------------------------------- Contractor's Name----------------------- ---/kR fit - Other ❑ Apartment House ❑ Commercial � Trailer Court ❑ Motel ❑ Installation will serve: Residence ❑ P+P yt-fQ-r-_.--_____________________ � ------ Number of baths ..___.--- Lot size _ '1? _- -- Number of living units: -------- Number of bedrooms _- Depth to Water Table .��t- Water Supply: Public system Community system ❑ Private ❑ P PP y: Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe, - Hardpan ❑ { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y� No ❑�(c.� --G`' -^ Previous Application Made: Yes ❑ No New Construction: Yes ❑ � /�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ l . - Materia------------------- - -------------- -------- S �c Tank: Distance from nearest well-----------------Distance:from foundation___..____________. -Ca Capacity��y:� No. of compartments--- ---------- ----------Size__.----------------------------Liquid depth----------------------- p y -. nearest well_________________Distance from foundation____________-_.____.Distance to nearest lot line_______._______ osal Field: Distance from Width of french-_____._-___---------------------{ 1 Number of lines----------------------- Length of each line____a- --;------------------- Type of filter material-------------------------Depth of filter material----------------------Total length_---------------- -•---- r? l n�-� -__Distance fr founddtion__d_O`----•--Distance to nearest lot line___�.Q Seepage Pit: Distance to nearest well_.M_ �----------Dep6h ,;2��------------------ 1 �' -Size: Diamefier-- -- -- - Number of pits._-------------- Lining material_ f -Liquid Capacity gals. Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining materia__..__.____-__._--.--------------- Deth--------------------• -------------------------- $iza: Diameter-------------------------------------- p - - ❑ Distance from nearest b0cling-------------------------------------- --- Distance ------------ -------------- Privy: Distance from nearest well____.-- - - - - ,,,{� _�97� . ❑ �, Distance to nearest lot ine-------------------------- --- ------=- - I descri e� ------R-P.4_E-_be"- ----- --------------- Remodeling d/or re g ( < --- � I/._ 127--------------------------------------------------•------------------ 4- ____________________________ ___________________________________.-____________.___.__.__.___.____.__._____.________ _ _ ____________________________________________________________________________________________________________________________________...__ I 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 the San Joaquin Local Health District. � ,.�I?_�--- --- -- t Contract ' ----- f3 � �------ � Or Si ned - _ w� _ _ (Plot plan, showing size of lot, location of system in relation to w Is, buildings, a . ., can be p ace an reverse side. FOR DEPARTMENT USE ONLY DATE------?f - --- ----------- --------------------------------------------- ACCEPTED BY--------------------- ------- DATE-------- ---- ---------- ---------------------------- ----------•- --- ------- ------- ----- ------- - REVIEWED BY----------------------------- -- ------ --- BUILDING.PERMIT ISSUED_------•-------•------------ ------------------------- ------------- - Alterations and/or recommendations:___.__:_-�;--,------- - - ------------------------------ ---------------------- --------------------- ----- ---------- ---- ---------- ------------ - ---- ------ Date-------------- ----- - ----------------------------- FINAL ------ - FINAL INSPECTION BY------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California ES-9-2M �0-52 Revised W-2400