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L4 APPLICATION FOR SANITATION PERMIT Permit No. ._........ 1 (Complete in Duplicate) �f 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 �^Co��ON; KKddna-o a No. 549. i3.►s�►l.fP a1ql9 JOB ADDRESS AND LOCATION_SAA.�,t A i q Owner's Name___--�T._L.__A_X17_.txlA1V_-.C_en1....rfb;�e---_____MR..o�i.�yAN-S�r1.j01 ___ PhoneS4d.&y---. .'42162 Address AY.T-00 .- 441-1L� c,�f' � 's=-.(fol`l•--------------------------------------------------------------------------- -- Contractor's Name R -------------------------------- ----------------------------------------- Phone -1:nf-6 0 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms ._y Number of baths I--- Lot size ---4,57. -- _____________ Water Supply: Public system ❑ Community system)o Private?''Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9- Hardpan ❑ Previous Application Made: Yes ❑ No X_ New Construction: Yes ;4-_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ptkblic sewer is available within 200 feet.) Se is Tank: Distance from nearest wel A% _Distance from foundation--.1_Q.� _.Material__ � No. of compartments__.___.__. !_--------Size-&-&'A.. ____ _ Liquid depth__671---: ____Capacity_-.$ Disposal Field: Distance from nearest well_60D."._Distance from ndation__/Q_t-_-__---.Distance to nearest lot line___ (K Number of lines-------I------_------ /__ _ Length of each line____-7_,� ek!_+�-_�� '__-.--_--_-._.Width of trench__ - .................. Type of filter material._��j�1C�__-_-_Depth of filter material --_._I_V"-----Total length--_-_','--4--__----------_........... ^ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-------------- 1� ❑ Number of pits______________________Lining material-_--_-___-__- -_-_..Size: Diameter.._--_____--.__.._.----Depth--------------.---_-:--___---___. Cesspool: Distance from nearest well----------------- from foundation---.----------------Lining material__________________-.______--__-__._-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well____________________________________________ Distance from nearest building__--_-.--__.._________-__---__._-_-__-_.-. ❑ Distance to nearest lot line----------------------------------------------------------------------- Remodelingand/or repairing (describe):--------- -------------------------------------------------------------------------------------- -----------•------------------------------------------- -------- .......................................................... ---------------------------- ------- ------------------.................-- ---------------------------------------------------------------------------------------------------------------------------------------------- I hereby--c-- ify hat I hav prepared t ' application and that the work will be done in accordance with San Joaquin County ordinances, St a s, and rul and regul ionsj quin Local ealth District. (Signed) . -- . -- Contractor) By:............------------------------------------------------------ , ----------------(Title) �.,��;)r'11o>rr� (Plot plan, showing size of lot, location of,system ells, buildi s, etc., can be placed on reverse side).FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY-- --= --------------------------------------------------------------------=------------- DATE./ REVIEWEDBY----- ---------_---------------- ---- --------------------------------------------------------------------------------- DATE...�.._... ------------------------------------ ------------------------------------- DAA`E..-..... 't-------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------- -------- Alterations and/or recommendations:------------------------------ ---------------- ............................................................ ---•----------............................... ------•-----•-------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ -------- ---------------------------------------------/-�----------------------------- --------------�-------------- ---5 - = --------------------------------------------- FINAL INSPECTION BY:----------_---- Date__----------- -- - ------•c- 1-- j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-2100