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'11�r Per No. -- - -��1---- APPLICATION FOR SANITATION PERMIT !{X -e-` - AW11 (Complete in Duplicate) �D - DlitDate 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. 549. ---------------------------------- JOB ADDRESS AND LOCATION--------9d--�-------------��-'-�----- ------------------------------------ ---- Phone �--�� OwnersName-------------- ----------- -----------------•---------•----- ------------------ � - ------------------------------- Add __________________________ Address---------------•---------------•------------------------ ---,[,-_---�-,--t--------- - - b k "� ------ Phone,---..------------------------- t Contractor's Name------------------------------------------------ ------ I� Installation wiil'serve: ' R'esid'enceA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel D. Other ❑ Number of living units: __.,,__,Number of bedrooms 4,___ Number of baths I___ Lot size -------:��_x --------------------- - i _ Water Supply: Public syste','n V Community system ❑ Private El Depth to Water Table -------- ft. a . ```<,h cter of soil to a depth':of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay ❑ Adob Hardpan Previous Application Made:#' Yes'❑ 'No V New Construction: Yes E] No E] PHA/VA: Yes El No El TYPE OFJINSTALLATION AND SPECIFICATIONS: [R septic tank or'cesspool permitted if pu'blic_�sp�jwer is available within 200 feet.] f i [, _2_�---------.Mata ial--- ------ 4 Septi T` nk: Distance .from nearest well!_._______.__Distance from foundation_ No. of compartments-----�------- � r D ----- z -Sic x Liquid depth Op Capacity-- t•.. 1 120 Dis osal Field: Distance from nearest well----------------- from foundation-3-v- --_____Widthcofttrench--est lomat Ike__-T----------- -------------- _____. of lines --------------Length of each line---------------- Number: - L, Total length-- ------ --------------- Type of!'filter material_ ___ Depth of filter material .------- _ ._ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_-__________.._. Number of pits- Lining material_------ ---- --Size: Diameter---=--------------- ---Depth--------------------------------- �` El Cess ool: Distance from nearest well___________----_Distance from foundation-------------'------Lining material___________--..._.____________--._. \� p ❑ Size: Diameter Depth--------------------------------------- -------------Liquid Capacity .----------------------gals. Privy: Distance from nearest well---------=-------------------.-------------------Distancejrom nearest building----_-.----------------•-----------------. v „--.. ..t .....�- Distance to nearest lot line--- ------ -------- - ------------------------ ------------ ------------------------------------------------------ , r - - - -------------------- p --------•------------------------------- Remodeling and/or repairing (describe)------------------------------ ----------------------------------^ ----------•------------- is --------- - ------------ --------------------------------------------------------------------------------------------------------------- 4 , r i --------------------------------- t --------------- --------------------- ' I ---- -------------------- ---------------------------------- ------------'i--------^-------------------------•----------------------------------------------------------------------------------------- ------- I ----I hereby certify that I(have prepared this application-and that the work will be dobe in accordance with San Joaquin County !I ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ✓ ._ .. w-- Owner and/or Contractor (Signed) f OPP ---- y 1 v � I ----------------- BY:------ = ---------------•------------ ---------------------------------------- {Title} (Plot plan, showing size of lot,location of system in relation to wells, buildings, etc.,*can Ibe placedon-reverse side}. I t FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY r DATE--------------- =------------------s ---- ------ -----•------------------------ ----------------- DATE---------(flr l REVIEWED BY = - ----- f ---- ---------=------- --------- -----• DATE--------------- =--------------------------------------------- ---------- ----------------- ---------------------- BUkLDLNGPERMITyISSUE�-------------------------------------------------------------- - _ -.-.:. . Alter ion nd/or . recommendations:----- * `r -------------- _-- --------------------------------------- ___ _ -_-._____ . r _ ! { ------------- ON BY: _` -- - .-.-�- - = � - -------- Date --•--.------.----------------------------- FINAL INSPECTI SAN JOA IN LOCAL'HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r Stockton, California Lodi, California Manteca, California Tracy, California / $-4-2M , Revised 1-57 P.P,CO.