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APPLICATION ICOR SANITATION PERMIT Permit No. ..--.`________________ ' (Complete in Duplicate) j I >. Date Issued ---- _b_ --------_- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. �F This application is made in compliance with County Ordinance No. 549. di JOB ADDRESS AND LOCATION_..--_ - - ___C- ------ f ----- ------------------- - - -- - --------- ------------- Owner's Name - ------------------ ---------- Phone-" -j/------- Address --Q-- - ----------- -------- ------- ---- - - -----------------------------------------------------•------- Contractor's Name_ t V-- - --- ----- Phone-- "'.,7 T Installation will serve: Residen a Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel U Other ❑ Number of living units: _-- Number of bedrooms _ - Number of baths -- �( r k 9' �- �- �fwot size _---- Water Supply: Public system ❑ Community system ❑ PrivateTkpepth to Water Tabl-71�&Ir_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lo m ❑ Clay ❑ Adobe gRL Hardpan ❑. 1 Previous Application Made: Yes I] No,91,_ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) geptic Ta Distance from nearest well ---_--- .Distance from foundation--------------------Material ----___--_--_- I No. of compartments-------------.-------------Size-----------•--------------------Liquid depth-------------------------Capacity---------------------- posal F• Id: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line------------------ Number of lines------------------------------------Length of each line------------------------------Width of trench---------------------------____-- (J • Type of filter material________________________Depth of filter material----____________ __Total length_---__-.._________________ Seeps a Pit: Distance to nearest well_ -_- -_______Distant r ou dation-�'b_____-.D- t cee to nearest IQA line --- _Size: Diameter- I. Number of pits----- ------ ----Lining material -------.Depth_�3TQ______-- , ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter------------------- ------Depth------------------------------------------- --------Liquid Capacity------------ -------gals. Privy: Distance from nearest well-----------------------------------------_------Distance from nearest building--------------------------------------- Distance _----__-_--____-__-_-___Distance to nearest lot line----------- Remodeling and/or repairing (describe)-------------- ------------------------------------------------------------------------------------------ -------------------•-------•------------•------------ ------------------- I hereby certify that I hay ared this application and that ghwill be done in accordance with San Joaquin County ordinances, Sta# laws rues and gulations of th San Joe quHealth Dis cf. Sr ned � -•rte.i - r, ContractcE) Y= -- -------------------------------------- Title I 1 - (Plot p an, sh win ize of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------- DATE_--_-_-•--____ _ ---------------------- ---------------------------------------------------- ------------- REVIEW,ED BY -------r - ---- - ------ ------------------------------------------- - DATE �r� '~`5 - I - -------------- BUILDING PI RMIT ISSUED ------ ------------------ --------- ---- ----------- DATE Alterations and/or recommendations-------------------------- = = -------------------------------------------------------- • - --- --- ----- -- --------------------------------- -----------------------------------------------•---------------------------- •-------------------- -------------------------------------------------------------- --------------------------------------------------------------------------------------- -----------1 FINAL INSPECTION BY:-=�---- -------- = -- -- Date------------- -- -- d ` 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 E5-4-2M 8-51 Revised W-2100