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1ww" � r� APPLICATION FOR SANITATION PERMIT" Permit No C5 4� .` i (Complete in Duplicate) D ate Issued - n Local Healt -,�_ __ Ap lication is hereby made fie the San Joaqui 1" This application is made In compliance with County Ordina ceQlNoc549r apermit to construct t and install the work herein described. I JOB ADDRESS AND LOCATION_.___ Owner's Name '_!�. 'Gl Address. .,,. _ ------ -------------------------------- -- Phone--- -------------------------------- ----------------------- ��.. ere --------_ --- ---------------- ontractor's Name ---------------------- ------------------------e - - Installation will serve: Residence A. Apartment House ❑ Commercial Phone--------------------____* I ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: ---/ __ Number of bedrooms ____2-Number of baths .�--___ Lot size ------7_ -X_ /3 Water Supply.- Public system Communitysystem PP Y= Y ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clayg Adobe,yf Hardpan ❑ Previous Application Made: Yes ❑ I No ❑ New Construction: Yes ❑ No ❑ ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank o`r cesspool permitted if public sewer is available within 200 feet.} f Septic Tank: Distance from nearest -__Distance from foundation----_ L? ` No. of compartments- �-- r// l Ma.ferial --------------------- ------------ )K --- S1Ze -.l /3 X_S_,Liquid depth- 7 E Capacity )-Z-U . ------- Disal Field; Distance from nearest well..�� ` , /e. a ,- Distance from foundation--__ - __.__-Distance to nearest lot line-------Number of lines_- _-- - __-- _�_ I-__Length of each line----------- _ - Width of trench �'----- -------- Type Il'of filter aterial*4-�.e�__�___Depth of filter material---___-.'_ . __._-_ ` Total length,--------------)d d --------------) 1 Distance from foundation----------- ' Seepage Pit:} Distance to nearest well________________� �___.--.Distance to nearest lot line___________ ___ ❑ ,,,4 ,.Number of its----------------------Linin , material------- g' ----- ----Size; Diameter----------------------- Depth--------- ------- Cesspool: Distance from nearest well------------ - 1 -Distance from foundation_.__-__� Lining material--------------- El Size:Diameter-------------------------- ----- r Depth ---------- Privy, Liquid Capacity - gals. Distance from nearest yell--------------- --------------__ _____ __Distance from nearest buildin ( ------- El Distance to nearest lot line---- "s.� _r g 1 emodeling and/or repairing (describe):---------------------- >!, ---------------------------------------• -----------•---•---------------.----- ---------- iI •----------------------------------------------- ----------------------------------------- ---------------- -. -------•---------------•----------------------•---------------------------------------- ------ ------------------------------------------------------ ---------------------------------------`"T"'rr I hereby certify that I have prepared this application and that the work`:will be done in accordance with San Joaquin County ordinances, State laws, and rules an 'regulations f the S in Joagciin Local Health District. ..' (Signed). � - ---- - By: -- ---(Owner and/or Contractor (Title)- Plot plan, showing.size of lot, location of system in relation to wells, buildings, etc., can The placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY4 - _ ^_ :„�� I ': - -----•---------------------- DATE--------- REVIEWED BY - -t-s tib,.+. ,Z - --- ----. DATE------------- ' --- 8lJILQ1NG PERMIT 15SUED------••------• _ .o.----- ------- ------•--------- •------ - `DATE.--------- Alterations and/or recommendations:__--cam_.------_ . _ ------------ - i - a _ ., - --•---. --•------ A --- xjI ---------------------------• - FINAL INSPECTION BY-------------- �. ------------------- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30o West Oak Street 132 Sycamore Street `y Stockton, California & Lodi, California Manteca, California 814 North "C" Street Tracy, California ES-4 2M 10-52 Revised W-2100 s _