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APPLICATION FOR SANITATION PER Permit No. V-- - (Complete in Duplicate) 3 Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ll This application is made in compliance with County Ordinance 549. JOB ADDRESS AND LOCATION _ J_ - ' Owner's Name---- �� [� ' „ --------------- ------------------------•- ...!3-------------- - ------ --------------------- Address .' e---LTJ- 9-new a. Phone-------------- Contrector's Name----------------------------- ---- ---------------•--------- •------•--------••-------------------------•----------------•----------•- - Y�. /� ---------------- a --------------•---•---- Phone-------f'--f .Q Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms A �___ Number of baths.___1__ Lot size _____�,�----�__ ��_®�___ Water Supply: Public's stem Communit s stem ------------•-- PpY Y Y Y ❑ Private ❑ Depth to Water Table _tpft. Character of soil to a depth of 3 feet: a Sand Ll Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1' Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr ell / -_.___Dista ce J{fom fo ndation_- --_--------Material-___- ./ _ No. of compartments__ - ----------,-._size * - �il�•Li Liquid de th__ •0 $ I q i? �-6.-.-----------Capacif Disposal Field: Distance from nearest weil_t - Distance from foundation._1_q`---•----Distance to nearest lot line________ Number of lines_�____ ____ _ -------- Length of each line_ jD rs•~ � Type of filter material_ 9 Width o{ tren h_+ _ ____-_ �. �•-- _..-_-:Depth of filter material__�_g---.___--__Total_ length__--�fOn�_ Seepage Pit: Distance to nearest well__1�lDQ'----__ D:sfarnc fr m oundation_. � W Number of pits__.___--._•- •�•--•.Distance to nearest t line-------� ___Lining material Ir _--__Size: Diameter__! [ De tn__ Cesspool: Distance fcom nearest well_________________Distance from foundation-------------- material- ❑ Size: Diameter-----L Depth------------------------------ -------- ------- -- ------Liquid Capacity-------------- --gals. rivy: Distance from nearest well_ -----------------------------------------Distance from nearbst buildin g -------- ❑ Distance tonearest lot°line--------------- ----------- -----------------------*_ -------------------------- Remodeling and/or repairing (describe):-------------- - ---------------------------•---------•-- ----------------------------- _________-___#__-__-__- F - r -:-- -- ------ -------------- ¢ ---------------- -- 0' 1 - ; _ ---•------•---- ti -� � _ r 4 ---------•----•---••-------------------- -- •------------------ •----•-------•-------------------•----•---•----------- -------- I hereby ce j1aw ave pr red this a plication-and that the work will be done in accordanordinances, tatules a d regulation of t San Joa uin L cal Health District, accordance with San Joaquin County 9 - (Signed)_- -_ �. _ ; ,_ ----- ------ SY:------------------------ ....---• - Contractor) ---------- Title �_ (Plot plan, showing size of lot, locationof stem i rQ! tion o wells, b dings, etc., can )laced o�e rave 7 -- ---------------- . _ y P se side). A-S ..I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'----------- -------------------------- DATE_--___--- -__ REVIEWED BY "= ii .Z ----------- ------------------ - ------- DATE. - - -----------------------i -------• ------ ---- ------- ' BUILDING PERMIT ISSPED---------------- 1' ----------••-------•-------•------- -- DATE - -------- ---------- , ---- aerations and/or recommendations: ---------- -----------= ----- r .ti ______________________•.___.-_____ .F �, __________________________________ _ . ----------------------------------- - .._-. ------------------------------------------------------------------------- -------_ • ------ ------------------------------------------------------ FINAL -INSPECTION BY:: " �/ 7•Pi =_. Date -3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streeto 300 West Oak Street 132 Sycamore Street�g - 814 North "C" Street ! Stockton, California Lodi, California Manteca, California Tracy, California .+ E5-4-2M ; Revised W-2100 % ' lF