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.3 •.. APPLICATION FOR SANITATION PERMIT Permit No.l --4- (Complete in Duplicate) ' Date Issued �_ ______-per d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he`ein escrii This application is made in compliance with County Ordina ce No. 549. �•:.. JOB ADDRESS AND LOCATION 7 --- . . ---- - ----------------------------------------------------------- �. Phone__.��--- -��------ OwnersName---------�----- ---- ---- ---------•---• --- -------•-•---_-,•t-_-------•------------------- - -------------------------- ------------------ Address �f `24 (!?'t.C+------------- / JJ----- ---- k Contractor's .Name--•--- ------------- ' Phone `7' a.- o - -------- w Installation will serve: Residence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.__-- Number of bedrooms __�=Number of baths _�___ Lot size ____._____.Q__----- - �_ ----.-_r-- t + Water Supply: Public system X Community system El Private E] Depth to Water Table 410__ ft. ,L. 1 Character of soil to a depth of'3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan_❑ ? Previous Application Made: Yes ❑ No X New Construction: Yes ;4 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 N.0-___e�!Distance from foundation--- ______________Material__.___..__- i• s / No. of compartments_ s�D�rXya .X 9 ----f--�-�--_-1 size - •- ----- Liquid deth__._'?'`. CapautY �� - Disposal Field: Distance from nearest we4o w�P_'Distance from foundation---4s--------.Distance to nearest lot l;in _-.______-_.__. Number of lines___�___�___.___ -----Length of each line----'r.- :Width-af"hrench----- �_-��------ ------------ S, o C 4- 1 ,Type of filter material________ ' ----Depth of filter material- - length_______ `` -_-__________-- IIrr �� 4 �`� �- Seepage Pit: Distance to nearest welf_NP_4- D•sstance from fou dation_______-- _ _-__.Distan�e to nearest lot line_ __ Number of pits-'-- Lining material. � 1�_Size: Diameter---- ��' -----Depth------'/2---5------ ---- ------ I� € 1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_------------------------ ----_- ��y ❑ Size: Diameter--=--------------------------------- Depth----------------------------------- ----------------Liquid Capacity----------------- Privy: ------------- -Privy: Distance from nearest well------------------------------------------------- nearest building----------- ;:______._______.__. ❑ Distance to nearest lot line------------------------------------------------------------------------------ ----------- -------------------- -----------------------� Remodeling and/or repairing (describe):--------------------------------------------------------- - --------- ------------------------------------------------ ,.�...7 ------------------------------------------------------- ------------- I------------------------------------------------------------------------------------------------------------------------------------- -------- } =- ------ ---------------------------------------- ---- I hereby certify that I have prepared,this application and that the work will be done in accordance with San Joaquin County ordinances, Sfc#e laws, and rules and regulations of,fhe. San Joaquin Local Health District. (Signed) R ----- ------- ---- ------Owner and/or Contractor) B - �-- ------------------------------------------------------------- [Title)- :. _ (Plot plan, showing size of lot,`locatip'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 5_ -.. --------••------- DATE-----------• -- ..? "� APPLICATION ACCEPTED BY------r------------- ------------------- ---------- V6�� -----• � ---- REVIEWEDBY------------------------------ --- --------------------------------------------------------------- DATE-- ------------- ----• -- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------:----------------•--- -- Alterationsand/or recommendations:------------------------------- ---------------------------------------------------------------------------•-------------------------------------------------- -------- ----------------------------- ------------------- - ------------------------------------------------------•--------- ------------- ------------------------------------------------ Y , ------------------------------------------- --- r �s FINAL INSPECTION BY------ -- ---- -- Date -------- --------7 � 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 E5-9-2M 10-52 Revised W-2100