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' APPLICATION FOR SANITATION PERMIT Permit No. V07,17_ __---- (Complete in Duplicate) - Date Issued//-...___.-1 _-- .. -- Applica4,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. 54?. } JOB ADDRESS AND LOCATION---- / P_ .o - ¢fir ----------? ---------------------------------- --------------------------------------------------------------- Owner's Name r '' <4'd/�f - � Phone - -�.��-•- --------�/ � _ =--'� -- --- Address- Contractors Name----- a ----------------------------------- Phone2 •-S__•�2 6 s Installation will serve: Residence U}--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms :;�__- Number of baths _`___ Lot size _-___-----__________________ Tf Water Supply: Public system 'pg-'Community system ❑ Private ❑ Depth to Water Table y--- ft. Character of soil to a depth of 3 feet: Sand f"Gravel ❑"""'Sa`ndy Loam ❑ Clay Loam ❑ Clay 0 'Adobe 09--'hardpan ❑ Previous Application'Made: -.Yes-E] No [t-"New Construction: Yes ❑ No [�J TYPE OF INSTALLATION AND SPECIFICATIONS: f � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E;s o gptio-Tank: Distance from f lies est well-----------------Distance from foundation---------------------Material------- _______________________.___._--------- 4 , No. of compartments-------------------------�ize---------------------------=----Liquid depth--------- ---- ---- Capacity-------------- ------- v Disposa Field.— Distance from nearest well .____.-----------Disfa-nce from foundation------- -- ---- -Distance to nearest lot line----------------- i Number of lines---:-------- - - ------------------Length of each line------------------------------ id of tench.------------------:--------------- / Type of filter material_________________________Depth of filter material-----------------------Total length_1------------------------------________-- r a_,::1 �d,4,,� 3 S .nearest to nearest lot line_________________ V1 Number of pits.;'---�.__________Lining material_sl__l t�Size: Diamefe-r__-_�_4.___._____...Depth_._._z��____________________ i s Cesspool: Distance fromInearest well-----------------Distance from foundation--------------------.Lining material-____..____-__________________-------------------------------------- [] Size: Diameter. -----------------------------------Depth-----------------.------------------------------- .-Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------•-__------:::__---------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line------------_-____-------------------------------- Remodeling and/or repairing (desc`ribe):------------------ -------------------------------•----•------••-----------------•-•--------------•--------•----------------•-------- -----------------------• --------- -----------------------------:-------------------------------------------------------------------------------------•---------------------------------------------------------------------- -------------------------------------------------------------- -----•------.--------.----------------.-------------_-----.---------------.--------.--------------.---.-------------------------------- E I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. /_� (Signed)............. (Owher and/or Contractor) =By:--------- -�'l' � ''--------------------------------------------------------------•--------.(Title)- =- ------------------ ------- ------------ (Plot plan, showing size'of lot, location qfi system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------------------ DATE �- --------------------------- REVIEWED BY r � DATE l BUILDING PERMIT ISSUED------_----- ••---------------------------------------------•---------------------------------------- DATE..--------------------- ------------------------------------- Alterationsand/or recommendations:----•---------------------------------------------------------------------------------------------•--------•---------------••---....-------------------.------ --------------•-------------------•-----------------------------....-._-----•----•----•--------•-------------------•-------••---------•-•---•----__.-_-.--------------•-------------•----.--------------._.. 1 . ----------------------------------•-------------------------=-------------------------------------------------------------------------------------------------------------=------------------------------------- -------------------- --------------- ------- -••---------------------------- - ------- ---- -- ---- ---- --- FINAL INSPECTION' BY:..__----- --------------- : `f ✓'� Date.- --�f---- 1 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 ES-9—•2M : Revised W-2100