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APPLICATION FOR SANITATION PERMIT No• '- --- • (Complete in Duplicate) ate Issued -- __ 5. ------ ; • Application is hereby made to�the' San Joaquin.Local Health District for a permit to con trust a din tall the work herein described. Se~ SDA �Y v�*t This application',is..made}n compliance with County Ordinance No. 544. W. 2-4 112 —(� I JOB ADDRESS AND LOCATION �D._ .1-. � 1(0 _.1-4—(L-17 i // --- ---------- Phone------- ------ Owner's Name-------------------�-----4--------- �''-<-f�v�y-------- _ ----•-- '. "� Address--------------------- �© -------- i --- , Contractor's Name---------- -- --------------------------------------------E Phone----------------------------------- [ Y Installation will serve: Reside ce T A artment House Commercial ❑ Trailer Court ❑ ❑ Other ❑ r --- Lot size -------_ -- J Number of living"units__/__ Number of bedroom __ Number of baths :_� / ` i Water Supply: Public system ❑ Community system 0 Private ®- Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ C(1 . r 1 `t Q - Previous Application Made:,Yes-❑ No [N New Construction: Yes No Ll TYPE OF INSTALLATION AND SPECIFICATIONS: .r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest'welLIP.-�.__?Distanc ro foundation--- __ ! ° .lvlate ipl------- ___._ - --- -- 1 p p� ,f _ ® No, of compartments---------2-- ----- Size . 6------ Liquid depth------- - ....---- Capacity-----,, a / v Disposal Field: Distance from nearest well--l�-2�/.___, Distance from foundation..�QA:y!-.Distance to nearest lot line_, __..-... Number of lines------------ .�. -----Length of each line---------6.d..._.�-----Width of french-------�.-----.... 2D---------------- Type of filter material.. �!fCr____Depth of filter material..-.___� .-- -__._Total length___......_._..... - _ Seepage Pit: Distance to nearest well-----------------_..Distance from foundation____:...__._.-__....Distance to nearest lot iine...:J`.--_._.. .- ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter-----------------------Qepth------------------------------ - Cesspool: Distance from.,. well.................Distance from foundation...-------...___...Lining material--------------------------------- - ❑ 6 Size: Diameter--------------- ---' epth----------------------------------------- ------Liquid Capacity - gas. distance from nearest building - Privy: Distance from nearest well------------------------ �. r. i. _ ,. .� ----------- ❑ Distance to nearest lot line--....:_....- `" --------------• •} ---'---:... f Remodeling and/or repairing (describe):--,-.._i.___.-- ---�---�-------'-•------------•------""""-"""-�--�-�"""�*'�x a _ I �----'----------•-----'----,-._i...__- ---------------------------------------------------- - _ --------------------- -------- --- --- •-..._.-_._--------------------------------------•-----------------'---------•---------------' - -------------- ----- - - -----'-------- -------- - - -- ----------------...--- I hereby certify th-a- -- _ t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and ulations of the San Joaquin Local'Health District. M-4 __- ----- ---(Owner and/or Contractor) , [Signed) . ..�- --------- ------------- -------------------- ----- - -------- - --- ---- ------------------------------------------------------- Tifle ---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART T USE ONLY --------------- 10 = APPLICATION ACCEPTED BY---- _._�- -------------------------- DATE REVIEWED BY --------- DATE------------------------------------------------------------ - -----------------------------------------------------------------------_------------- Y BUILDING PERMIT ISSUED-----•-------------------- ------------------------- DATE --------------- Alterationsand/or recommendations--- ----------------------------------- --------------•-----------------------------------------•---•---•-----••---------------------------•-----------•------- ----------------------------------------------- ------------------- -------------- --- --- B' ;k- r � FINAL INSPECTION BY:. = Date---- .- ---- - ------- ----------- ---------------------------- SANi JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wet Oak,Street i + 132 Sycamore Street 814 North "C" Street Stockton, California 1_047Califorrnia Manteca, California Tracy, California ES-9=2M 0-52 Revised W-2100