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r f APPLICATION FOR SANITATION PERMIT Permit No. l (Complete in Duplicate) Date issued __ /r yj-_ i M I S r 1, t71-65C7-01 Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here's described. °IWOk This application is made in compliance with County Ordinance No. 54.P. r JOB ADDRESS AND LOCATION______ "� }�' -' ' "" ---------------- Phone..---------------------•--•------- -- Owners Name.-_. '1 �� •-•----------------------•---••-•-------- - Address------------•---------------•---- ----- -- ------- --------- -. Contrector's Name ------ Phone.---•--•----------•---- .. Installation will serve: Residence ®-Apartment House [_1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths _______ Lot size Number of living units: -/�____ Number of bedrooms � f�� i ater Supply: Public system 171Community system E] Depth to Water Table ft. I �_ J W Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (51—i ardpan Previous Application Made: Yes ❑ No e` New Construction: Yes ❑ No -�—• F j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well__::___.`__:"_._Distance from foundation__________________-Material-----------------.____.___.----____________---_- t No. of compartments------- ----- -- ---- Size--------------------------------Liquid depth---------i---------------Capacity.----- --- ----------- Dispos eld: Distance from nearest we1L-..__.__._k- _y Distance from foundation---------------------Distance to nearest lot line________-.__-___ Number of lines---------------- -------.Z Length of each line----------- --------- ------Width of trench------------------------------------- Type -------- -------------------------Type of filter material------k----------------`.Depth of filter material---..------.--.- -.....Total length-------•--------------------------- --, Seepage Pit: Distance to nearest well-. :".Distance from f��oun�ation__-1AP.____._-.Distane to nearest lot line__.: -_----- �-- Number of pits------ ___ --------Lining mater"iaiM' aeL!LZck-Size: Diameter-_V11------__.Deptn_:�O- ~------------ - Cesspool: Distance fi,om nearest well-----------------Distance from foundation-- ---------------- Lining material____.___..--_..______"____.__._____. s ❑ Size: Diameter ---------------------------------- Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well..............-------------------------------....Distance from nearest building----- --------------------:----------- - --- ❑ Distance to nearest lot line----- ---------------------------------------------•- -- -•-------=•-•-----------•------ ------------•-----------•--- ------------------ " 6_0 .i . - ---••----------------------------Remodeling and/or repairing (describe__________ _- -•---------------------------•---------------------- ------------------------------------------------------------------•-••---------------------•---------------------•-"----------------• ----------------------------- p I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County . ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � R ------- -- ----- •-- r ---------------------(Signed)--------------- (Owner and/or Contractor) - ------------------- Br------------------------------- -- --------- -------- --- -- -- - - --- --------------------------------- (Title)- [Plot plan, showing size of 1q, location of system in relation to wells, buildings, etc., can be place on raver side). FOR DEPARTMENT USE ONLY rt APPLICATIONACCEPTED = ---- -- ------ - -------------------------------------------------- DATE_ ------ ----•----•-•--------------------- REVIEWEDBY------------------------ ----------------------------------------- --------------------------------------------------------------------------------------------• DATE_ ,'=?--•----•- •---•-------------. BUILDINGPERMIT ISSUED---------- ---------------------------------------------------------------------- ------------------ DATE - Alterations and/or recommendations:---------- -------------------------------••--•-------------------------------------•------- ( ----- ----------- ---- ------- - ---- ----•- -------- �- � 6----- - •-�: ------------------------ ----- -----------------I- --------------------•--------------------------------------- ----- 4 �- �i� �. 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 ) '�' E5-9–�� 145446 aTwODo t1-54