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APPLICATIO94 N FOR SANITATION PERMIT Permit No. __l1_o_-�•S_ "w (Complete in Duplicate) 7 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constructnd..i�rs all the work herein described. y�This a plication is made in compliance with County O dinance No. S49. ref- — JOB ADDRESS AND LOC TON_____ -- 7 1 103. Owner's Name----- ----------- �- y -- • -_---- ------------------ --------- ------ Phon Address-.--------- e-------------------- --------------- ----------- Contractor's Name__________ _ -' -- -------------------------------------------------------I------------ - - ---------------- Phone------------•--------------- ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other 24--- Number of living units: _-"_- Number of bedrooms _-`- Number of baths __/__ Lot size ___ f__ _ ----------- Water Supply: Public system ❑ Community system ❑ Private M--I�epth to Water Table/_i-_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [I Hardpan ❑ Previous Application Made: Yes ❑ No �r New Construction: Yes R- _`No No ❑ FHA/VA: Yes �No ❑ € TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel__-� _Disfiance from foundafiion---� , ____.Material___--No, l of compartmentsSize_ I i -L�---X--V-__Liquid depth--- �__� Ca acit __ Disposal Field: Distance from nearest ell__ ,�j Distance from foundation p y �p f _�/2__-____.Distance to nearest lot line_j��-_f Number of lines________________ _ Length 6f each line___-__ f � T e of filter material_, � % -�-----------Width of trench--_- Yp _ --,2_ _ � _ _ Depth of filter material._ __e_____________Total length__-___ ; -------------------- Seepage Pit: distance to nearest well ____ _ - T �- _-____Distance from foundation___________________.Distance to nearest lot line----------------- ------------------Number of pits----------------------Lining material-----------------------Size. Diameter------------------------ Depth--- ---------- -'--------------- Cesspool: Distance from nearest well------------------Distance from foundation-------------_-----Lining material_-________--____ ❑ Size: Diameter------------------------ ------- - Depth Liquid Capacity �----------gals. 6 Privy: Distance from nearest well___________________________ _ t ____________________Distance from nearest building - Distance to nearest lot line _ g ---------------------- ____ Remodeling and/or repairing (describe):___-_ --------------- - -------------•------------- = ---------------------- - ---------------------- h _____________________________________________________________________ __hereby certify certif that Ihave - - ----•--------------=-'-=�''--------------------- ----------- --------- ---- ----- - - ---- Y Y prepared this application and that the work will be done in accordance with San ,doaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District . . T , (Signed)-- -----------------------------------------( r Contractor) $Y:------------------------------------- ----------------------(Title--- (Plot plan, showing size of lot, location of sy in relation to wells buildings, etc., can be laced on reverse side-- :E g p FOR DEPARTMENT USE ONLY s; APPLICATION ACCEPTED BYi .Z DATE -�7 : ' REVIEWED BY -------------------------- - ---------------------- DATE , BUILDING PERMIT ISSUED_____________________________ ___ --------------------------------------------------------------- DATE..---------------------------------------------------------- --------------------------Alterations and/or recommendations: -------------------------------------------------- d ---------- --------•--- ------------------------------------------------------------ ------------------------------- -------------------------------- - ---- ------- -------•---------------=-- ------------------------------------------------ ------ -- ----------------- -- ----- --- ----- ------------------------------------------------------•-------------------------- ----------------------------------- FINAL :---- ----------------- FINAL INSPECTI (-Q Date-------- _ G -' ___ ___________ ______________-__N__-__----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street132 5 I' yeemore Street 814 North 'cC' Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9=2M , Revises 1.57 F.p,CO. r ,