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?' APPLICATION FOR SANITATION PERMIT Permit No. ___ 7--------`- �rY (Complete in Duplicate) Da}e Issued . -" - -- S -3 s. k Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LQCATION------- -. _ -------- -------- fJ � 7" ' - Phone__c.��-�-��1----------- Owners Name----------- -- - - �j Address--------------------------------•'•�--------�.,.`--.--------- ----•---------------------------------------------------------•-•-------------•-- - ---------- --------•--- --------------- r f --•------------• Phone__ -,� ------- --------------- 7 Contractor's Name-------- - ------------ Installation ---- = r Motel Other ❑ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Lot size 6!q_:'�� <7 Number of living units: _ .___ Number of bedrooms __Number of baths Y Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ElNo New Construction: Yes [j 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 well-----------------Distance from foundation__.-_______"______.Matena______________________________..____._ -----Size--------------------------------Liquid dep0Capacity ❑ No. of compartments-------------------- q p' ti Disposal Field: Distance from nearest well-------..__.-----Distance from foundation--------------------Distance to nearest lot line__"______________ A ❑ Number of lines k;_-_______I-----------------------Length of each line-----------------------------Width of trench.---------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------- est'welL. 'UCS_--Distance from foundation___ �ls-..__..Distance to nearest lot line___ ___ __ ___ Seepage Pit: Distance to near Number of pits:_f--------------"--Lining material_I -GP- -- __.Size: Diameter--- rr�/Q,-.Depth-- 40---------------- -- Cesspool- Distance from nearest well ____________Distance from foundation-------------------- Liming mamaterial_ gaIs, El Size: Diameter--------------------------------------Depth-------------------------------------- -- q Capacity -- Privy: Distance from nearest well______-_.-"---------------------------------- -Distance from nearest building----------------------------------------- Privy: ,• 7`--------------------------------- ❑ ---------- Distance to nearest of line------------------------------------------------------------------ Remodeling and/or repairing (describe): ` '------------------ ----------------------------------------------•---------"------•-------------------"----•--------------- ---------------------- Y -�� -- _ ---------- ---------- -- ---- ---=------- -- I E ;/ -----------------------•-- --------------------; I hereby certify„that l have prepared this application and that the work will be done in accordance with San Joaquin .County ordinances, State laws; end rules and regulations of the San Joaquin Local Health District. -- ------ -------------- -,==-(Owner and/or Contractor) (Signed) ------ - j ” r £ -- :_._ _- ---------/"--�-------------'-- •-�'-='`•-ef' ---==�`-- -----(rifle).....-. ------` --`--------` -`-`''.-'- --------- BY:--•------------ •--- ------ u (Plot plan, showing size of lot, location of system in relation to wills, buildings, etc., can be placedwn reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------Jf 96------------------- DATE fes.--' ��z-... Ud . I REVIEWED BY------------------------- . ---.-s--- ----- ---- ------------------------ ------------------------------------------ DATE_---- ----------------------------- BUILDING PERMIT ISSUED-----_------------------------ -------------------- •- --•--•----- ------------------------------•-- DATE---------------------------------------- Alterations and/or recommendations:------------------------------------ --------------••-- -------------------------------------------•--------------- 1 ---- -•------------------------------------------ ----------- ------------------------•------•---- --- FINAL• INSPI=CTION-BY--------------- ----------------- --- C--------------- i I SAN JOAQUIN LOCAL HEALTH DISTRICT. 1 300 West Oak Street 132 Sycamora Street E14 Forth "C" Street 130 South American Street Trac , California Stockton, California Lodi, California Manteca, California Y G[—v-9M ; Revised W-2100 -