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Ki.101 , TCATION FOR SANITATION PERMIT Permit No. ,,,�'_3__-� /J (Complete in Duplicate) Date Issued 1 _!!!A97A Application is hereby made to the San Joaquin Local Health District for a permit to co rust and inst a work herein described. This application is made in compliance wi. my di gnce No. 4 + 44, JOB ADDRESS AND LOCAT ON- {f -- -,------- ----------------- , Owner's Name----------.5 ---- ---f�/!` - ------- ------� - __ Phone...................----------------- -------------- Contractor's Name--------------- ------------------------------------------------------- ---- -------------------- -------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ M•o�t+el E] Other ❑ Number of living units: _: --__ Number of bedrooms ___I___ Number of baths ____j.-Lot size _-___`� '_l ? Water Supply: Public system ❑ Community system ix rR ivate or Depth to Water Table _� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay Adobe F1Hardpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu tic 11wer is available within 240 feet.) Se i Tank: Distance from nearest well__'T'" Distan rIfti,6_/0_ __--Maten 1 - __IA No. of compartments,_________''jj ______Size-- Liquid de th__________' ________Capacity___ _ ___�(_ .- Disposal Field: Distance from nearest well___x Distance from foundation_____-1 0 .-__Distance to nearest lot l' ...... Number of lines.- 1�+ -Length of each line___, .:T Width of trench} - p Type of filter material---4T�Depth of filter materiaL_____�_�----------Total length_---b-+ ----------------------------- Seepage -•____ ________________ f Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot line................. 171 Number of pits___----------------------Lining Lining material-----------------------Size: Diameter_______ _____-•______-Depth--------------------------------- Cesspool: ____-_____.______ _________-Cesspool: Distance from nearest well-----------------Distance from foundation.__.___________--Lin-ing material--------------------------------- ❑ Size: Diameter--------------•----------------------Depth----- -_-- ---------------------------------Liquid Capacity ----------------_---gals. Privy: Distance from nearest well_________- --------------------------------------D—i s-Fa rice from newest building__..: -------------------- El ____ -____- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------=---------- ------ Remodeling and/or repairing (describe):--------------------- ----------------- •------------------- ----- ----------------------------•--•----------•--------. -:.---- ---•--. ----- ----------------------- ------- ------- -------- ------- -------------------------------------------- ---------- ------- ------ ------------------------------- --------•- ----- - ------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, State laws, and. ulati s of the San Joaquin Local Health District. (SignSi` ed) aC!':_ -------------------------------- --•-- --- ----- ---------------------- (Owner and/or Contractor) ( i9 )-- ------•--•-••- ----- ------ ------•- B ------ •---•---------------- ---------------------- --------------- --- ---------------------------------(Title---------------------------------------------------------- (Plot - --- - ----- ------- ------- ---(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY----------- a __ _ ------- _ _ DATE --� REVIEWED BY------- ----- _ DATE - ; BUILDING PERMIT ISSUED-_- ----_.- -_- DATE_ Alterations and/or recommendations:--- _ ) �- -- --------------------------------------------------- ---- -- -------- ------ ----- - ---- ---- .............------- ---- --------- ---•------ - - FINAL INSPECTION BY: _ Date !_- _ _" --- --------- 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 8.51 Revised W-2100