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s� r Kto' APPLICATION FOR SANITATION PERMIT Permit No. (in 14 x {Complete in Duplicate) Date issued �- 3- ---- Application � _3 Application is hereby mzi'ftompliance he San Joaquin Local Health District for a permit to construct and install the work her scribed. This application is made with County Winance No. 549. JOB.ADDRESS AND LOCA710N1____.._ / Owner's Name----- -'�S•....... ••`- vtrCl � ---- / - ----- - - ------- . Phone.---a��-_'�_/_��---- -- Address ' ------------------ - ------- Q --- Contractor's Name - -.- C..r' --------------- Phone----- - --o rt ❑ ❑ Other Ins+allation will serve: Residence �` Apartment House ❑ Commercial ❑ Traile Court Motel ❑ Number of living units: --I___ Number of bedrooms __� O i _.__". Number of baths .__ ._. Lot size _�___-_-- ---�.__�-�-�--------------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ AdobeZ Hardpan ❑ Previous Application Made: Yes E:]' No New Construction: Yes ❑ No ❑ � � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sprtic� Ta.k Distance from nearest well_________________Distance from foundation-------------------.Material____._____-_____ No, of compartnTents--- ---------------------Size-------•-------------"--------- ----------- ---- Liquid depth --------------Capacity------ --------- - P osal- field. Distance from nearest weft_.._"_________._.Distance from foundation___--__________---Distance to nearest lot line__ ___,____-._ V. Number of lines-----------------------------------Length of each line-----_-----------------------.Width of trench- V. Type or filter material------------------------- -------------- -------------Depth of filter material----------------__-----Total length--------------------------------------_--• Seepage Pit: Distance to nearest well_N0-1A-E----Distance from foundation---1_ ---------- Distance to nee resfi lot line - Number of pits -_)______---_____Lining material._ Size: Diameter__. �j _ _ ��__.----De th_ _ ' Cesspool; Distance from nearest well-_______________Distance from foundation--------------------Lining material---------_--------------------------- Size: Diameter-----` -------------------------------Depth------------------------------ ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------- Distance from nearest building-_'-,----------------------------❑ Distance to nearest loft line___________________________ r - -- ---------- Remodeling and/or repairing (describe):------ -_ ---- 1� -- ----- ---- - ----- - ----------- -------------------------- ---- - ------------------- ------------------------------------------------------------------- ------------------------------------- ae ------------ -------------------------------------------------- ------------------------ --------- ! hereby car+if a ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State las, and r es and re tions of the San Joaquin Local Health District. (Signed)--------------------- - ----- -- ---- ------ } ' or . G' 8 L (Plot plan, showing size of lot, location of system in r +ion to wells, uildings, efc., can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------ ------------------- DATE------------ Z = 153--------------- REVIEWED BY --------------------------------- ---------- - - ---------- DATE------- ------------ BUILDING PERMIT ISSUI=D---------------- --------------- -- ------- ------------------------------- ----------------- -----------------•----------------------------. DATE------ --------------------Atera#ions and/or recommends+ions: --------------________ _ -"--• ----- -----------------••------------------•-- ---- - ----------------------- =------------------------ --------------------------------------------------------------- ------ ,------•----- ----- FINAL INSPECTION BY:_.___.. alrl�_12 - Date 16-.- _;2_3S i - 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-9-2i 1 I0-52 Revised W-2100