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� � ,., APPLICATION FOR SANITATION PERMIT Permit No. _ ._ ---------- (Complete in Du licate),,:t Date ssu _ _ S-Al Applica+ion is hereby made to the TSan iJoaquin Local Health District for a Permit to construct and install the work herein described. This application is made incompliance with County OrdiN co No. 49. JOBADDRESS AND,LOCATION.. _ '---- ------- -------------== - -------------•--•----------------------------=------------------ t = a . Owners Name------ 4 �------- -- = `° _ _P. . .. . -... _ _ - - --------- - - --- -- Phone ----- Address ------------- -------------------------- 17 �__ i Contractor's Name ' - ------ -------------- a z Installation will serve: 'Residence � = Apartment House ❑ Commercial ❑ Trailer Court ❑ Mc�otel ❑ Other P G Number of living units: _ '_ urs-nber of bedrooms __� Number of baths __. '' Lot'size -------01_ __ ____f _ _________________________ .f.._ f Wafer Supply: 'Public Comrnuriity system ❑ Private.❑"�Depth to Wafter Tabl -"ft. r "� i Character of soil to a depth of.3_feet: Sand ❑ Gravel E] Sandy Loam E] . Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application'Mader Yes ❑. No New Construction: Yes 92---N-o TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or c sspool'permiffed if public sewer is available within 200 feet.) { _ Sept'c Tank: Distanee'ifrom nearesr well____________--_,Distance from foundation----------- of compartments-.. ------ - Sfize------=-------------------------Liquid depth---------:------------;Capaci#y I' Number of,lines____._____________________________Length of each undation______------------ Width. of french_.________._"_-_"___"'.___.____ Type of filter material-_________ "___ Depth of filter material ._ Total length--------------------------------------- .1 ____ _____.__ . .. .. ._ x � � .r - — ;t Q o r Seepage Pit: ; Distance to nearest well Citi-�+r� _ Dis#ante.from"fou"dation __ Distance to nearest lot line S Number of pits:- ---- ------Lining.material_ Size..Diam`eter 3 'r ....Depta�--- 5----------- ' Cesspool: Distance from nearest well_______ _______Distance from foundation .__..__ Linin materiel__ _. __. -__ __ __!____-_.-. g [] Size: Diameter- --- ` ----------------Depth-. -`-------------`-------------------'--------_Liquid Capacity-- -- = .gals. y1 T ' _Distance from nearest building ____ Privy: -D�stanee from nearest well---•___-- -----"---- :---"-�- ------- 9------ -------------- "------- ❑ �- - - -------------------------------------------------- - -------- Distance to near_est,lat Ime._._�'�'__________________ - _r..Remodeling and/or repairing {describe):-=-- ::---------- ----• - -------_------ ---,- -----.----------- . - ------------------- - :_- -- - : . --T ---- ------- i------------------------- Z---------- -- •----- `------------------------ - --------- , . hereby certify that have-prepared4isonsoli the San J4haunhLocal Healthle-doncin accordance with San,__"""""" "--"-_. ------- } t6 Joaquin County ordinances, a laws;and rules and regu a edF f--« ---- '- ---- (Sign } a an r on /o C +racto k .y-----------------------------------(Title (Plot plan, showing size,,of lot,'Iodation-of sysf in relationto)wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT USEiONL•YJ APPLICATION ACCEPTED BY-------- ---- - '° �',� = - i ---_ -----•-------- DATE - •• y-- ------------ -- i.-�----'-`-`!._.-------- - DATE ---------•-------_----•- BUILEWED BY-'---- --:-�------------------ ---�-----'---`--------��-`-------- -- --------------------- REVi t DATE _= .. -------------------------------- -- DING PERMIT ISSUED------ =--""-- 4 .. Alterations and/or reeommenda+ions:_ =----------------- -------------------------------------- ------ --------------- -------------------------------------------- --------•-•-"--•--- -------- ' --------------------- ---,--------------------- --------------- 1 . . ...a k. .. 5. -------•---•----------------------------------•-•--••-- ------------------------------------------------ ------- - -- a FINAL INSPECTION BY --------- ---- ------ ------------------ + SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South-American Street i 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M-d- Revised W-2100