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' 3 -y �` 4• �� -�" APPLICATION FOR SANITATION PERMIT Permit No.c ' _ S�J_�__ y"C 1�p1� (Complete in Duplicate) Date Issued /X _ /i6ed.Applicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc k This application is made,in compliance w'f ConOr financ49 �-0.k D .-C . A-(G fGc C_� '.A ' .JOB ADDRESS AND LOCATION---- --Y�,L, Y ----- �i`.D_- -�f t . fix' - - s �•+. -----� `o t � ----- , f ----- Owner's Na -------- �-1- � --------- -- ----- Phone---�,�--------------------- Address -------- �J ,Q l -------- r, Address..... ----•-! 7�-�---------->� �^�I ----- ��1 --��-/--r------------------------------------------------------------ Contractor's Name---- b-a---A--A----- A- 1 -t-, - -_- n.�11 ,� � /Y t------ --•--- Phone- 7- ,(P®7-------- Installation will serve: Residence 'rte* Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other ❑ Number of living units:CNONumber of bedrooms _ __ Number of baths dA(CLof size _,04 __________-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 8---- ft. (/3 Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan I P ❑ ❑ Y � Y ❑ Y ❑ ❑ P { Q Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No 1 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________________Distance from foundation--------------------Material________--___________________________-------- ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-----------------------� I Disposal Field: Distance from nearest well__ _ ___.Distance from foundation__ __.____Distance to nearest lot line---3'.._____.__ Number of {ines__ _n( __-„__ _-------Length of each line-_--__ •__ �--___- Width of trench, _�f��______________I Type of filter material- len of filter material_______�_ ____:___Total length____ _ _______________________ Seepage Pit: Distance to nearest well___________________ Distance from foundation...........---------Distance to nearest lot line_____________ ! Number of its__________________ Linin material,_-___-_______________Size: Diameter------------------------De th_.___-___-.____ Cesspool: Distance from nearest well_______________Distance from foundation_____________-___.Lining material_________________________________ ❑ Size- Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------galrir, Priv Distance'fForn nearest well----- Disn tace-from-nearest building ❑ Distance to nearest lot line------------------------------------------------------------------------------ -- ---------------------------------------------- I Remodeling and/or repairing (describe):___- ” __ f r�---- ------------------------------- -` a_ � �______ - --------------------------------•----------••----------------•------ -------•------------------•--------j`� �� ---------------------------------------------------------------------------------------------•----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules regulations of the San Joaquin Local Health District. (Signed)----Lb -0, -P--4 // -- ----- - -- --------- ----- •---f--------------(Owner acrd/or ontractor) By:-------• L.eL�a---------- -- - -- ----- - ---1----------------------------- ---------------- plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pi He`d on reverse side). (Plot P �C, ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ti.. DATE --------------------------- REVIEWED BY------------------------------------- -------------------- BUILDING ----------------- Lj BUILDING PERMIT ISSUED4 ---------------------------------------------•------------------------------- QATE---- --- ----- ----- -- - - = — ---- 1 Alterations and/or recommendations:------ ---- -----------=----------------------------------------------------------------------• -------------------------------------------------- 1 ---------------------------------------------------------------------------------------------------------"-----------------------------------------------------------------------------------------------•------------------- -------------------------------------------------------------------------------=--•-----•---------------------------------------------------------------------------••-----------------------------._...--------------------- -----------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------- ----- ---------------------------------------------------------------------------------------------------------- --° i FINAL INSPECTION BY:--------- --- --- - - --- ------- ----- Date-------�-__--------��---- :- SAN JOAQUIN LOCAL HEALTH DISTRICT 138 Souih American Street 300 Wes+ Oak S+reet 132 Sycamore Street 814 North "C" Street r Stockton, California Lodi, California Men+eca, California Tracy, California ES-9-2M B-51 Revised W-2100