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�G00 ,1r�Se yZ ( � APPLICATION FOR SANITATION PERMIT Permit No. .._ �..?..Y (Complete in Duplicate) 0 2 Date Issued y_.7 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. 54499. JOB ADDRESS AND LOATION4 / � ` - ------ Owner's ---- _ Name_..-------- P� teAddfir) ,�--------- Address----------...... ress---------------- ....... -• ...... -- ------ I- ---!` ... r Contractor's Name------------------------------------------- -------- --------- --------------------------------------------•---------------------------- Phone-----............................ ------------- Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: -----I- Number of bedrooms ___Number of baths .__l_. Lot size ------ � )_____--_---- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _�A__d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 4 Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No f\� New Construction: Yes X No F]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...VrDistanc fro foundation----L0---------Materi W^ No. of compartments----------�i�____.__Size..__ _X____X.�._Liquid l!depth____________ _________Capacity... -0.0--____- Dis o al Field: Distance from nearest well....210,A.iistance from foundation.../.?l____ _.__.Distance to nearest lot Number of lines........ _Length of each line----(D__�__�_- .Width of trench--------A-444--/1-..-_-______- � Type of filter material...S'r .Depth of filter material_--_.-_/--,0-------Total length---------J.Ato---___-__-____--____ C Seepage Pit: Distance to nearest well--------------_-------Distance from foundation....................Distance to nearest lot line----------------- El 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-------------------------------_.-_-_._-. ❑ Distance to nearest lot line----------------------------------------------------------------------- ----------------•--------------------------------------------- - 1 „ r re airin (descr' e): + �'- r . ` ......Remodeling and/ � L __6 -� --- - � -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed).....0 -- - _- --------- �!L-------------- ---------------------------•------------------------------------------------------------(Owner and/or Contractor) N By:--- -- C'� --- - --------------------------------------------------------------------(Title) (Plot pla , s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ----------------------------- ------------------------ DATE-------------------------- REWEWED--BY- ---- -- ---------------- I� __ DACE: _ -' — tom; ------------ BUILDING PERMIT ISSUED - -- ---- -------- ------... DATE----------- - -------------- ---------------------------- Alterations and/or recom ndations__ __ ______ __________________________________ __________________ ---------- ��rt.P.. �-'/"* 2.r�..r Q-"3 - ------------------------------------------------------------------------------------- --- L �C.=� y ...._..-- �' �� ------------------------------------------------------- x1A. ,_ FINAL INSPECTION BY------------------- -- --------------- ...... Date----------- ----------------------- n-------------- 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