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#APPLICATION FOR SANITATION PERMIT Permit NOK _._I___pJ-. .(Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 50. ,��` JOB ADDRESS AND LOCATION-------- I ____ ]Jr_-_ _ __/�_f?• jr_ :_--- f �} /) -------------------------•---------------------------------------- Owner's Name----------------------------------------J'I�41' `��------- x G_�_ . JK- - ------------- Phone------------------------------------ Address-. -`-�p- ------- -- ------------------------------------------------------------------------------------------------- Contractor's Name--------------------------------- I ---Q ----- Installation ---Installation will serve: Residence D4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___,/__ Number of bedrooms -5--- Number of baths J__, Lot size ----6.4_'__.--y Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table3pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I)( Hardpan ❑ Previous Application Made: Yes ❑ No•jg- -New Construction: Yes ❑ No ❑ jy/�� P � G TYPE OF INSTALLATION AND SPECIFICATIONS: T/ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic T Distance from nearest well_________________Distance from foundation--------------------Material ____....__________.____________--_______.._.__. No. of torr artments-------------------------Size----------------------___ 56 "r"/ P Liquid depth Capacity----------------------- O _ osal i I : Distance from nearest well_-_._._______-_-Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines------------------------------ ------Length of each line------------------------------Width of trench----------------------------------- Type of filter material____ ____._____-F_____Depth of filter material----------------------- length---------------------------------------__--_N� ', LJ ,fi ___.Mance to nearest lot line___/_0,_�, Seepage Pit: Distance to nearest well__ _ Q��--_-•-_Distance f om {{oundation____ _. �^ - Number of pits...-----------------Lining material(ei.�[3��___-___Size: Diameter______--oi�...__ .Depth_',��_�_.__--__-._-.._.____ �f Cesspool: Distance from nearest well___________..__Distance from foundation____________________Lining material------._.__-___-_____________________. Fj Size:`Diameter-----------------:--- -------------Depfih-----_-----------:_------ y------------------Liquid Capacity--------------__:- gals. Privy: Distance from nearest well ___-____________-------------------------------Distance from neard!i buildint_:`:_..__= ❑ Distance to nearest lot line__________________________________________._ Remodeling and/or repairing (describe) ----------------------•----------------------------------•---•-----------------------•-- ------------------- ----------------------------------- --------------------••------------•-------------------------------------------------•------------------------------------------------•-------------------------------------------------- I hereby, c tify that I he prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to �Iawjs, ncl r and regulations of the San Joaquin Lac I Health District. e (Signed)----- -------------------- ---- -- ---- -- - Contractor) By: --•---------------- ---- 9 {Title) _I _. PC 0,R---_---------------- s plan, showing size of lot, location of syste i relation to wells, bui n s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- --•---- -----------------------------------•----------- DATE-------- ------ ---r-5---- --- REVIEWEDBY------------------------------------- ------- •-•--------------------- DATE F------------------ BUILDING PERMIT ISSUED----- DATE Alterations and/or recommendations:----`--- --------- --------------------------- - - ---------------------------------------------------- - ------------------------------------I---•------------ ---------------------------------------------.----•-------------------------- ----------------------------------------------------------------------- -----------------------------------------------------•----------•----••------------------------•------------------------------------------------------------------- ---------------------------------------------------------- a ---------------• ------ ------------------------- ----------,----------------- ------------------------------------------ ---------------------------------------------------------------------------------------------- FINAL INSPECTION BY: - --- ------------------------------- Date-----------3 --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 10-52 Revised W-2100