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j APPLICATION FOR SANITATION PERMIT Permit No.-4(-..4.t.4... (Complete in Duplicate) Date Issued -_t�/..�__3 Application is hereby made to the San Joaquin Local Health District for a p t ruct and install the work herein described. This application is made in compliance with County r 0i o JOB ADDRESS JND LOCATIOISL (� y '�'-- --. Owner's Name. ------- --- 0 Address ... T r-' !S ./ - :1_ nt�_C'. 1P.,"t ' e1 .2_.2. q Contractor's Name -----"" Phone 9 '-Q Installation will serve: Residence L Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms _-l"Number of baths J-__ Lot size ------ ----------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ff Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� Septic Tank: Distance from nearest well_PDo_'__Distance from foundation../_Qa.---..Material----�-�4--`�� No. of compartments.___. -Size_.:M~x4. �x ..Liquid de th_.,5-Z_'_"-_____-_CapacityApQ�."�" Disposal Field: Distance from nearest well___ 91z'.__Distance from f undation-_-_/__0 _---.Distance to nearest lot line.. ---- ------d .Number of lines-----j__-_-_-_�------------------Length of each line------ of french---a4- '--_--_.---___---- Type of filter material- - ______Depth of filter material..-/.S a ._/ Total length----- -7. --x7 ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 1-1 Number of pits----------------------Lining material-----------------.-----Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material------------------------------.___--_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F-1 Distance to nearest lot line----------------------------------------------------------------------- ----------------------------------------------- .---------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------..................... ------ ---------•-•-----------•---•--- ---- --- ---------------------- --- ------------------------------------------------------------------------------------------------------------------------••----------------------.-- I hereby certi y the I have prepa ed t is application and that the work will be done in accordance with San Joaquin County ordinances, State aws, nd r les and re ul tions of the;Saoaqui.n Local Health District. (Signed)--------------- -•- . --. --.... ----- --- ------- --- - ---------------------------------- -----=----( Contractor) BY: ------------------------------------------------------- --- -- --- (Title) / �1(Plot plan, showing size of lot, location of system in relatiwells, buildin , etc., can be pla a on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- - - - ---------------------------------------------------------- DATE..... REVIEWEDBY --- --------------------------------------------------- DATE ----------------------------------------------- BUILDINGPERMIT ISSUED---------------------------- ---------------------------------------------------------------------- DATE----------------------------------•=-----------•--••------ Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ...----••--•....•----•-----•---•------------------------------------------------------------------ -------------------------------------------------------------------------------------------•-------------------------- ------------------------------------------------------------------------------------------ ----- -------------------------------5 ---F--I-N---A---L-- INSPECTION BY------------------------------------------------------- - - Date----------- � _ --"'S ------------------------- 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