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Permit No. +� `3- ' F FOR SANITATION PERMIT -te -7— APPLICATION 1 T Date Issued } ,�..w�.�.--•tet:. (Complete in Duplicate) F , Applicaa-ion is hereby me an 's# to construct and install the work herein described. ade to the SJoaquin Local Health District for a perm F This application is made in compliance with County Ordinance No. 54 . , •------ --- -�- JOB ADDRESS AND LOCATION------- •- -" _ -----.--.Phone-------------------------------•---- - - - ------------ Owner's Name- ----------------- - - - - --------•----- ----•-----•---------- ---------- 4- Phone---------------------•------------- - ------'--------------------- ------------- (� �---- - - - -- ------- - Other [�- Contractor`s Name----------- -- ---- Commercial ❑ Trailer Court ❑ Motel ❑ Apartment House ❑ __ _____________ Installation will serve: Residence ❑ p _ Depth to Water t g , t .�.. r+vote, . size.--------•-----�=-- -----•- - ' � "" - rooms --------PNumber of baths .------- LO Teble "------• ft. Number of living units: __ . Number of bed � I Public system ommun�ty•system ❑ Clay Adobe�Hardpan ❑ Water supply: Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ Character of sail to a depth of 3 feet: !Sand ❑ ❑ Previous Application Made: Yes ❑ No New Construction: Yes [�}'NO _ A TYPE OF INSTALLATION AND SPECIFICATIONS: 4 _ (No septic tank or cesspool permitted if publisewerstanaeaf abmefaun�da?on�_f �.�-- ---.Material_____� G= � � Il � L ��' -- Capacity-t' --j q�- Distance from nearest well�lkl?" -- Liquid depth-_______-" 1 Septic Tank: i '. No. of compartments_____�j�------ ----Size___.__.__"----- aQ f. n '-_Distance from foundation_____ —-- --•---Distance to nearest lot line___ ----------- ---------------- __________ /fJ' _..W idth of trench_---- Disposal Field: Distance from nearest _:_ Length'o each line_- ---- Number of lines____.--4----- Total length_----------1C r--------------------- Type or' filter material_,- Depth of filter material___.. I- k Distance from foundation--- ---.Distance to nearest lot line______________"-- r t Distance to nearest well-_._______-_-__-"--- Seepage Pit: ----Lining material----- ---------- =----Size: Diameter�r-- ----------- ---- -..Dept'n--------------------------------- Seepage ---,- ----------------•--------- Number of pits-------- ----- g -----Liquid Capacity"-------------------------•-gals. Distance from nearest well_"_____----"-----Distance from foundation-------------�--- -Lining material___-_-""--------------- ---------'--- Cesspool: _De th------------ - ti ❑ Size: Diameter € p ` --------- ------------------------- ---- -Distance from nearest building-------- -----------:--•-------- �. Priv Distance from nearest well__-__ ----------------------- ------------• ------------ ` ❑ ---------------- ... Distance to noarest lot ine--------- ---------- s � 5 _-____-_--_ "_________________________.__.__.__.___.____._____._____. .-- ------- ____-__. ----- ------------------ Remodeling and/or repairing (describe)#_____----_ --- ------ k ---------------------------•-----•------- ---•---------------- ------------------•----- • --- """ ------------------- - -- are�d.thisnapplica+,ion.andrthat.the.work.will be done iin accordance with San----J----o----a-----q--- oa uin County 9 I hereby certify that I have prep s, and rules and regulations of the San Jo'quin Local Health District. { s ►` (Owner and/or Contractor) � ordinances, State law ----------•--•---------------•-- ---------(Ow - ,' I --- - ---- ----------------------- ned --------- _. ------------ ------ ------- Title 'g } - ..� B •..._.__.,_-------------------- • Ings, etc. Ican be placed on reverse sl e. y. build! 4 (plot plan, showing sue of lot, location of system in relation to wells, FOR DEPARTMENT USE''.ONLY DATE-- _ v l; APPLICATION'ACCEPTED BY ------=----------• DATE------------- --- REVIEWED BY - """`�.-t-� - D TE. - BUILDING PERMIT ISSUED------- ---------------------- j -- or recommendations:,._------------ ~ k. Alterations and/ --•"-•"----•- -- _--- •-- - ------ - I r -•-� c �p Alt ------- q{ . f8 4 _ -._ _______...... _____________ 4 � t •--- Date----------- �- FINAL INSPECTION BY:..__.'_-"----------•- ------------•---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT $14 North "C• Street c 132 Sycamore Street 300 West Oak Street Tracy, California 130 South American Street Lodi, California Manteca, California Stockton, California c[-9-2M Revised W-2100