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-�,t�x APPLICATION FOR SANITATION PERMIT Permit No. 2_7 (Complete in Duplicate) Data Issued N/7_ Application is here y made to the 5 Joaquin Local Health District for a permit to construct and install the work herein desYcFea. This application is nnad9.in.g? Viqnt with Count Ordinance No. 549. 1 .11 , . . 7 mopR A v:,% 'N P4 Ir X7 ; o, &2 17,6&S-62 JOB ADDRESS AND L J- OCATION-0 ---------- _111_5_4�---tf /�_f zye------- Owner's Name-----------•----------------------- ------ ------- --- ---------- -------------------- ------- Phone..... Address..................... .... --- 0__X . --- ------------ 0 ___ Contractor's Name-----------------r----------- --- - ------ C---P-- ------- ------------------------------------------- Phone------ _"- ._. ?- ._ Installation hone------- Installation will serve: Residence," Apartment House F] Commercial [] Trailer Court F] Motel I-] Other El I- C- I F� ....---------- Number of living units. __j---- Number of bedrooms ---�_"_ um6er of baths I______ Lot size -------�Vj(— --------- - ------ Water Supply: Public system F] Community system El Private X Depth to Water Tablej-49ft. Character of soil to a depth of 3 feet: Sand E] Gravel L] Sandy Loam [j Clay LoamjX Clay E] Adobe, Hardpan ❑ Previous Application Made: Yes E] No )( New Construction: Ye� No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted iftublic sewer is available within 200 feet.) Septic Tank: Distance from nearest ---0-'o....Distance from founclafion_]_P�-------Material__jC_Cll x No. of compartments_._ ----------- depth._._ ___C p ty - -- ---- aci --- rI Disposal Field: Distance from nearest well..96**.-Disfance rom founclafion--l-412 .. .....Distance to nearest lot'line___ 4- -01 01 Number of lines______I---------------------------Length of each -----------Width of french-A-4--'" 1 Type of filter material--- Depth of filter mate ria .01.....Total lengfh_____j_',0---f Seepage Pit: Distance to nearest well_./Ad7_'0-----DistanCe ndation___ _12__* Dis�ance to nearest lo�tine_12 Tr m ------ 19 Number of pits----I----------------Lining materi�1-"- A-- Size: Diameter__194_1r!��----Depth------- V.0.............. Cesspool: Distance from nearest well_________________Distanccunclafion------------------.Lining material-----------------------4�----------- El Size: Diameter--------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------.--Distance from nearest building.-________.____- _________---------._.- F-1 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------- ---------------------------------------------------------------------------------------------------------------- ------------------------- --------------- ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------- ------------------------------------------- ----------------------------------------1-------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------*------------------------------------------------- I hereb ter i'that I have d this aplication and that the work will be done in accordance with San Joaquin County av """ ordinances, ate I s, and lule:spa regulations f the San Joaquin LL cal Health District. 4A ... ..t (Signed) .... --------- -------------- ---------- ----Nil,---- ------ -- ---- ------------ 40 -ontracforl -41, By:----------------------------------------------------------------------- - tjeK,�.. ----buil---- ... 12.A. ._-(Title)--- odxj etc., can be pla6ed on reverse side). (Plot plan, showing size of lot, location of system ijefation to wells, bui ------------ gs,--e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ --------------------------------------------------------------------------------- DATE-?_;:-—------------------ ------------------------------- REVIEWEDBY------------------ ------ - ------------------------------------------------------------------------------------- DATE -—- --------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE- Alterations and/or recommendations-- - ------- --------------- ----------------------------------------------------------------------------------- -- -----------_----------- -----------_------------- -----------•---• -------•-------•--•-------------.--------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------_._--------------------------------------------- -----------------I----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ -z -/"4/- ;;-a FINAL INSPECTION BY------------------ -- ----------------- -------------------------- Date----- -------------------------- 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 10-52 Revised W-2100