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t/ elap - Permit No.32...7. 41i- y C :. � APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) d Date Issued • Juin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin pp e with C This application is made in comp ianc County Ordinance No. 549. � 7 - --- --- ------------ --------•-----------•------•-------•------------- ----•------- JOB ADDRESS ANDLOCATION____ __-y_-_-_-_-_____]___ -h2-07 --- - ...------------ ---------------------- ----- Phone =' Owner's Name---------------------------- ----- - ----------------- -------------------------------------------------------------- ---------------- --- Phone---Address ------------------------------ _ _ Contractor's Name--------------------------•-- - Ins+allation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms __�-- Number of baths _1___ Lot size ____ --------------- Q r - - Water Supply: Public system ❑ Community system ElPrivafelk. Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No)Kl_ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' r 41- Tank: Distance from nearest well_ _®__,_____Distance from foundation__�fU_________.Matenal____ -"-------.---- '`� . ._ " Capacity- o(,-3 No. of compartme;ats.___" . Size -19'-4�------Liquid depth._.---- ... - ---- Capacity_ ? - i.. I Disposal Field: Distance from nearest well---- Distance from foun ation___ _______________Distance to nearest lot line_______._______. Number of lines------------ --------- -- ------------ -- of french._____. _4 ��------------- ___Length of each line_______ Type of filter material----f `� 1�--Depth of filter material--------- Total length---aD-- ---------------------- p g ___ stance fro foundation__fQ''--------Distance to nearest lot line__.__ See a ePit: Number of pits.to ---st-w `-- --ming mpaterial� ----Size: Diameter__.. 1± Depth ----------------- . i Cesspool:.- t Distance from nearest well-______.._.____-Distance from.foundation__________'.______.Lining material_"____________________.___._-._____' ..i->ga�LL.. ;,4,,�w �� liquid Gapaci --- ------gals.._ ❑ Size: Dfameter----------------------------------- -Depth ------------ - tY'=` :.,,...__. F Distance from nearest building------------------------------------------ Privy: Distance from nearest well-----------------------" , T• _______________""_ i ❑ Distance to nearest lot line__-'''__..______--"----- --- ----------"----'-'------ "--- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ---------•---------------------------------------------------------------------------------------------- I -------------------------------•-----------•------ --------------"------ -----------------------------------------------------------t--------•---------------------------------•------ -- --------------------------------------- ---- --- - ----•- ------ ---- ---•--- •---- ---- -• - -- -- ! hereby certify that ! h ve p epared this app4icatio�and that th'e work will be done in accordance with San Joac{uin oun+y ordinances, State_laws, an les rid regulation of +he San Joaqui Local Health District. _-------- ---------•--------------- ---------------------------- (Signed) (Qwn�F qtr Contractor) ------------ - (Title) 1 SY= - ------ ----------------- - A .___ -�t (Plot plan, showing size of lot. Iota lion ofLsyss+1m in relation wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I._. - ; -.- --'------------------------------------------------------- DATE REVIEWED BY --C( DATE---�-------------------------•--- -------------- REVIEWED-BY PERMIT ISSUED-------------- ---------------------------------------------------------------------- DATE------ ---------------------- --------------------- Alterations and/or recommendations:------------------------------------------------------------------------------- ----------------------- ----------------------------------- t -------------" --------•----------------------------------------- --------------------------[ FINAL INSPECTION BY:------------ - -- --------------------- ---- ------ - � Date-- ----\V -�-- �.� ------ -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. E5-9--2M io-52 Revised W-2100 " '