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I APPLICATION FOR SANITATION PERMIT Permit No. .... 1 3 t vCom lete tin 'Duplicate) `- � p i Date Issued -_ _ _-- Applica{ion is hereby made to he San Joaquin Local Health`District for permit to construct and install the work herein described. This application is made:iri co rhe with County Ordinance No. 549. ] '.-•--- _- +__ __ __ _______ ___ ^______________._._------:----------•--•--•-•---------_•-- Ji JOB ADDRESS AND LOCATLON__________________ ___ ____�--_-- ------------ - -- - is • Owner's Name--------------(.-��--- - - •------ � � --------------------------- -- Phone--- -AddrAddress--------------- ess----------------••------=-----'------ •-------------------------------------------------------------_-------------------------------------------•-------------•-•-------------------------------•_...- Contractor's Name---- •-- ..-. -----------------------------------`---- ------ ----------------+-------------------- Phone----------------------------------- Installation will serve: ',Relshiden4', e,, ©—Apartment House []�Commercial ❑ Trailer Court ❑ Motelee er Number of living units: ��Number of bedrooms _`_- __ Number of baths __ otksize -------- ___C!- ___11___ ��__J________ ,h �1 ; . . Water Supply: Public sy�em i. Community system ❑ Privaie ❑ Depth to:Water Table'--'------ ft. Character.of soil to a de h a 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe rd an p„ ❑ ❑ ; Y ❑ Y ❑ Y ❑ P ❑ Previous Application Madel: Yis ❑ No ew Construction: Yes o ❑ 1 I TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tan k$or�cess of permitted if public sewer is available^within 200 feet.) + eptic Distan,�e from nearest ural)_______________Distance' from foundation uid de th Material----------R.___._..________- ----- No: of.co Fpartments-------------------------- Size ---'------ ,.....---- q p, ------- - --- --------Capacity--_------------------- PC -- --- ---------•-- I f. 1 r fi i Disposal Field: Distance from nearest �I it A�D.istance from founda ion___4_a-_-- istance to nearest lot line___ r� Number of� lines________ ___-_�____ Length of each line `34:Z. ..-__S�/idth of trench----------�n ___ Type of filter matariaL_ ____�4 _ De th of filter material____. _. �� ___.Total length _ __.'�-�_ _ 4. Yp p -- 9 , l _ Seepage Pit: Distance t��nearest well___________________ _Distance6,from foundafion_...-...":___Distance to nearest lot line_.--___.__-______ I ❑} Nu'mb'r of pits---- ---- -----Lining mlaterial = ` Size: Diameter Dept X11 Cesspool: Distance from nearest well__`____ ._ - =Distance from foundation-----______________Lining material-------------------------------------- 4 Diam4ter--------- ----- Depth----- --------------------------.__.--------- _.__Liquid Capacity gals. Privy: ce fT m nearest well- ---, ------------------ ----Distance from nearest building --------------_----. Priv Distan� dd , �. ^- T - ❑ ce t0 nearest lot'Irne..... -----------------------------------•---- ---------------_ ------------------------------------------------------------- - -------- _ Remodeling and/or r pairing describe):---- ----- ------------------------ i ' = --- ---------------------------------•------------------------------------------••.... . -----------•--•-•-- ° d� - --�- 1 i --'---------------------------'------------------I------------•------•---•-------------------_----- ------------------------ i t -------------------- -----------------------------------------4-----ll------------•----------------------- I hereby certify that ha ; prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State s, and rules a regulations of the San Joaquin Local;Health- District. Signed ,k- � - ----------------- ---------------------(Owner and/or Contractor) t i By:- ------------------- ,------••---..,. . `----------------- I ---------------------------------------------------� (Title)------------------------=-------------------------------------- (Plot plan, showing size of tot', 'location of-system in relation to wells,;buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY tl } k —s APPLICATION ACCEPTED BY ----- ---- ---=---=-----_------------------------- DATE--------------- -------------------------- ---•--- :=' I � � REVIEWED s13Y,-•- : --------------------------- ------ ---=-•------------------------ DATE---•-----•-•--------------------..�--------f------------- Alterations and or recommendations: = DATE-: :_....... BUILDING PERMIT ISSUE'D__--------------------------------------------------------------- 4 I1M . w s ------------------------------------------- ------ •-------------------------------- -----------------—-------------------------------------------------------------------------------------------------------------- 1 "lad ----------------------- ----------• -------------------- - - ----------------------- ----------------------------*---_------------ I----------- ---- i 1 ' 1G 0. ------ . -------------------------------------------- ____________________________________________________ - t �� -- - ------------------------------------------- SAN I ------- 2- r � ll FINAL iNSPECTIONi'BY: _ : ------ &Ihl " _________a_ ____________L_' _____ ---------- --..____.- ____________________________ SAN ti--� JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, CaliforniaI Lodi, California Manteca, California Tracy, California ' I � � ES-4-2M Revised Wi�2100