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APPLICATION FOR SANITATION PERMIT Permit No. . ..3. ..... (Complete in Duplicate) ``-)- Z. S G Date Issued .--.------------------ 7 (P S M D rJ7, r7 ST 173 -o_-go -z Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and in�falljhe wor -herein described:, This application is made in compliance with County Ordinance No. 549t JOB ADDRESS AND LOCATIONS•� �._.- ' r ' Owner's Name---{.` .�.r:'�-.F.!� '��. �t� v Phone... ---•-•----------------------------------------- ----- Address. ............:...:.... ?------'------ 1 Contractor's Name------------=---------•�--------------------------------------------------------• --------------------------------------------------------- Phone---------------•-------...._- ---•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court lylotel,❑ Other .k / �j Number of living units: ___1---- Number of bedrooms _ Number of baths I----- Lot size7__ qt___---_-__� k Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Ca Adobe0'/"Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ Gz-- ' Previous Application Made: Yes ❑ No 91' New Construction: Yes 2�No ❑ �i �; TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public ewer is available within 200 feet) Septic *ank: Distance from nearest well--,.x__ �Dis+a ::e from foundation O_.. . ._. aterial____ [ No. of compartments---------------- Size--t1,#. .rr'.._-_-_--Liquid�♦,d,eptthh_ .-----------------------Capacity_..rl � . Dispas I Field: Distance from nearest well. -------- Distance-.W o line.., -- ----+ Number of lines___________ ____�_..___.__- ---LLe Length of reach line foundation Widthcoftfrench--est I "> �,7 Type o ------------- f filter mater Depth of filter material---_.--- otal length-------------- n_5------_- /� f Seepa Pit: Distance to nearest w II;� •�:9,�_-Distanc �o ;foundation�_o-?�.bistance }o nearest lot li Number of pits._________1-______-Lining materal -.-: Size: Diameter-------5-b�-_____Depth_-_ __ '-_ y Cesspool- Distance from nearest we{I-----------------Distance from foundation-------------------- Lining material--------.----------.------------------- El .__-_--j- ordinances, ❑ Size: Diameter--------------------------------------Depth---------- -----------------------------------------Liquid Capacity--- -----------------------g Privy: Distance from nearest well------------------------------------------- Distance from nearest building---.-__.___--.-----_----------.----- ❑ 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 San Joaquin CouState laws, and rul s and regulations of the San Joaquin Local Health District. t—� -- -------------- --------Owner and/or Contrac (Signed)----==--- -�`�� _--- •---------------�•'� - -<---:--------------�--------------------------------------- - - - ( /0Y� ---1 ----------------------------------------------------------------------------------•(Title)------ -----•--------------------------------------------(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 APPLICATION ACCEPTED BY w --------------------------- ------------------ -- -------- - - DATE_-------------- - REVIEWED BY----- -•---------------------- DATE-- -•--- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----_z--`._------•----------------- Alterations and/or recommendations------------------ ----------- -------------•-- -------------------------------------------------------••-----------------•--••----•--------------------------- -----•-------------- -----------------•-------- -------•--- ------------ . -- - - ? - - --r S - ------------ --------------------------- ----------- -------------- f - -- _ - r FINALINSPECTION 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 FS-9 t45446 ATWOOO