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APPLICATION FOR SANITATION PERMIT Permit No.3--- (Complete in Duplicate) 1 !9'- Date issued --- ---- �.-- e Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. w This application is made in compliance with CoVT Ordinance No. 549. k {JOB ADDRESS AND LOCATION____-___--_-------- `-� fir.v., �. �,�/ L f --------------------------------------------------------------------------------- Owner's Name _ ?- yi.1 �r•i'�-E �``�`�5` -y / -/ ---r--------------------------- - -------------------------------------- Phone Address------- 134 /i�"�' A ----�- ------- 1 R Phone Contractor's Name-- -------- Installation will serve: Residence ® +Apartment House ❑ Comm ci ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedro6ms-,1- Number of baths ---L- Lot size ----------- Water _-_.---_-Water Supply: Public sysfe Community system fl Private ❑ Depth to Water'Table _______ ft. tf Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loarr Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ m It , Previous Application Made: Yes ❑ No� New Construction: Yes ❑ N—o S 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest ance from foundation-- __---------.Material__--------_----____---_----_---._- i' No. of compartments_ i' Size-#--, depth-- ----------------------Capacity , ----------------------- Disposal Field: Distance from nearest well__-l_�.---_Distance from found tion--!_d_�-----__ -Distance to nearest lot y Number of lines________________ +1 I' Type of filter material--- -_____.Dpthhoff filtehmlatenal --I_ _------ Width of trench------c *-------------- - g � - `` i-Total length----------- A_. -F* Seepage Pit: Distance to nearest well--------------------`-Distance from foundation------------ to nearest lot line_------__--_---_ . ,❑ Number of pits----------------------Lining material-----------------------Size: Diameter..- .:--------------Depth-------------------------- r Cesspool. Distance from nearest well------------------ Distance from foundation------------------- Lining material___.------------___----_-__-_ IF { ❑ Size: Diameter ;. Depth----- nLiquid Capacity----------------------------gals. Privy: Distance from nearest+:welt-----------------------' --------------------- Distance from nearest building------------------------- ---- Distance to nearest.iot:line — +..- --_—„�.,_ -- _ ------------- 1 Remodeling and/or repairing (describe);------------------------- - I f ---�-----------•------------------------------------------ M--------------- -:-------------------------- I -.►R, -- ordinances, State laws, and,ha s and regulations of the San Joh - -ui County ------------- -- - -- hereb certify that I have prepared +his a lication and that the work will be done in accordance with San Joaquin County Joaquin Local Health District. (Signed) r ------- -- ----------------- 4--- -- ------------------------------------------------------------ ner � .� w an /or Contractor] � Y� c a�_.� ._ _:.. --------- -----------------------------------------------------Title ----------------------------------- (Plot pian, showing 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_ ,-t 'c' TE--4:7K--- REVIEWEDBY-------------------------------------------- ------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED----------------------------- -- ----------------- DATE Alterations and/or recommendations:__-.----_--__. - Az�FINAL INSPECTION BY:--- ------------------- Date-_.S`_/.Z-rf_.3 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 i