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r 3 APPLICATION ATION FOR, SANITATION PERMIT I Permit No. ......`1l.-(ix-11- (Complete in Duplicate) - J I I Date Issued ._-�d--_r i A cation is hereby made to the San Joaquin Local Health District fore permit to construct and install the work herein described. ` pp nce with Count Ordinance No. 544. This application is made 1n compliance y JOB ADDRESS AND LOCATION--------- -`----(- �-[ N------------------------------------------- i -------------------------------------------- ---- - -------------- -------- --- --- Phone------------------------------------ Address -------------------------- ----- 1 } } Contractor's Name-------------••--------- [ Phone - " E Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' , A Number of living units: Number of bedrooms ---ZNumber of baths I---- Lot size -------------A--X------------.--------------------- Water Supply: Public system ❑ Co ymunity system ❑- Pri`afe g.,Depth to Water Table -/,,3__-ft. yk Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam ❑ Clay Loam [IClay El Adobe Hardpan E] l � Previous Application Made: Yes ElNo ® New Construction: Yes No ❑ TYPE O ,INSTALLATION 'AND,SPECIFICATIONS: (` o septic tank or cesspool permitted if,public sewer is available within 200 feet.) q Septic Tank: Distance from nearest well-- -__Distance from foundation----- - - --------Material -- _!.`"4'-----------_---------------- No. of com artmerctsL'------- ©-----Size-_-• -_u� -Liquid depth------ -a. ------CapacitY-----�rd-4------ Dis osal Field: Distance from nearest well---_.-...µ:__-- Distance from foundatio: Q-"---.Distance to nearest lot line----�----,� Number of lines-------_- .------,y- .1-----Length of each line------ ......- ,. y With of trench..----- - ------------- O . !Type of filter material- -�'-+��--_-Depth of filter material-- - ---------slob 1 lengt -------------I2-Q--_---___---__---- f - -----.--Distance from foundation-------------N---.Distance to nearest lot,iine-----.---_------ Seepage,Pit: Distance to nearest well___ +'°---- _ _ _,� . -._ _ ❑ Number of pits------- -Lining rn. riel--� '`_ ----Size: Diameter .` - Depth a Cesspool: Distance from.neares} well---h-_-.--__-O'istance from foundation------------------�.Lming matef�ial--.--._---___-.---_----------__--- ❑ Size: Diameter-----------�:----- -46.10# �e.p h ---------------------------------------------'.Liquid Capacity--------------------- -----gals. Privy: Distance from nearest well-__-__--!---------------------------------------Distance from nearest building------------------------------------ --------------------- ❑ Distance to nearest lot line--------F------------------------------------------------------------- - ---------------- Remodeling and/or repairing (describe):-------11- ---------1---------------------------------------------------------------------------- -------------------------------------- -------------------------------------------------------•---•----- ---------j--------------------------------------------------------•--•--• --------------------------=••------------------------------------ - ! i-------•-------------------------------- - --- -------------------- -------------------------------g-------•--- ------------------------- ------ ----------------- ------------- I hereby cer ' y that 1 havc1pre, d this application and that the work will be done in accordance with San Joaquin County ordinances, State S. and r lesla P e ulation /b he San Joaquin Local Health District. (Signed} rr -------- ------------------------------------------------------ --(Owner and/or Contractor --- ---------- - '`�- - --- Tale (Plot plan�showing size of lot, Iota!on system in relation to wells.buildings, etc., can be placed on reverse side). FOR` DEPARTMENT USE ONLY APPLICATIONACCEPTED BYA------------------ --- -------------------------------------------------------- DATE---------- 7---- pF, S3------------------------- REVIEWEDBY---------------------=-----=I------------------ ------------ --------- `---------------- "-- --`�.=------ DATE-----------1 ' Q ------•--------------------------- BUILDING PERMIT,ISSUED------------------------- • DATE `- --------------------------------------- Alterations and/or recommendations:----- -------_--.- "-----------"---------- '---------------------------------------------- ----------- % --.-...------ ------------ ............ •t----------•----------------------------------------------------------------------------- ./ -------------------------------------------------------------------•------------------------------ -------- ----- ---- --------------------- --- -- ------ ------ ------------------------------------------------------------------------- ---- -------------------------------- -------------- v - FINAL INSPECTION BY:.-- - --- --------- Date...l G------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street 300 West Oak Street 132 Sycamore Street S14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 10-52 Revised W-2100