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A,,,,ICATION FOR SANITATION PERM Permit No. <br /> �/ y\ (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No 549 <br /> JOB ADDRESS AND LOCATION_.. ! (""( """""------ - <br /> Owners Name. -------------• <br /> ?. {. :7..?z r rs.:a.-a. ::-----------, - e' - - e----.. Phon7 V-1 1-z- --- <br /> Address------------------ . ..........—.....-.............--- _.•-r <br /> Contractor's Name.- ........�! t 4=a-'� - ::r �..: ....... .................... ....- one--------:-------21_wr <br /> Installation will serve: Residence.a, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -./...i. Number of bedrooms _,3__ Number of baths /-.... Lot size .-)j------ ------------------ <br /> Water <br /> -------- -------Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table !�t'ft. <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pg Hardpan❑ <br /> Previous Application Made: Yes ❑ NoV New Construction: Yes ® No ❑ <br /> .. TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> n AJ� a<3.Es�G/� <br /> l�f.-------.Materiel-----....................----- --------- <br /> Se tic Tank: Distance from nearest well---�Q-......Distance from foundation....-- <br /> P� No. of compartments - 2c r .Liquid depth!......cT <br /> -----Capacity Capac ty..-P�4 <br /> P 6 3,, fas� <br /> Disposal Field: Distance from nearest well.._70.'--...Distance from foundatgqrj.A---_--......Distance to t nearest lot line-... .- ..... <br /> ` <br /> Number of lines.......�...-.t..:_i_.�f./....--Length of each line-._s .L2-:"-......---..Width of trench.-sx�..S!__---------------- <br /> Type of filter material..�.�a:.._Lus,_..Depth of filter mater .. �..f �....-_Total length---. .4'.----.---..-_-.--_-- <br /> Seepage Pit: Distance to nearest well.10-0 -.......Dist a fro foun tion-.. .......Distance to nearest lot line-... <br /> ` Number of pits.... .............. Lining ma eriaL.Ms�-. _,:Pl-.. ze: Di eter-------3-vhf.__Dept h---a'i.�_.__.._............ <br /> � <br /> Cesspool: Distance from nearest well..--_----.--.,-D nce from founds " ----------- ---- material------------------_._..._...------� <br /> ❑ Size: Diameter---------------------_--------...Depth------.............-------------------------------Liquid Capacity..........................gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------........................ <br /> ❑ Distance to nearest lot line----------_-----­- ............................ .................--...........-............................. .......----------- <br /> Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------_...............•----------- <br /> ----------- <br /> --- <br /> --- <br /> -------- <br /> ------- ------------------------------------'--•------•---------------------------------'•--°------------------------------------•---------------------------------...-------------------------•---..-. <br /> --------------------------------------------------•----------------........—---------------,--,.-..-•---------------------—............-------------------------------------------'--------------------- <br /> see I herebycertify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> y P ordinances. State laws,-:!Idr as and regulations of the. $an Joaquin Local Health District. <br /> (Signed) . Li ----- -``--/i'------------ — i f' ------------- ' --- -- ----- ( sec and¢or Contractor) <br /> f ----- <br /> (Plot plan, showing size of lot, location of system in relation t ells, buildings, q-*, can be placed on reverse side). <br /> bee FOR DEPARTMENT USE ONLY <br /> LAPPLICATION ACCEPTED BY.......................;. DATE.-.-...__ <br /> REVIEWEDBY...................................................................................._------- .............................. DATE.... -- - -- -- ....-......- <br /> BUILDINGPERMIT ISSUED----.......................................................-........_............................. DATE.................. ...................................... <br /> Alterationsand/or recommendations:......................................................----------------------••-`--------------------•----._.------•-----••----•------------- <br /> .......................................- ...................................................--..................... ........................----------------------------------------------------••-•------- <br /> M ----- ---------------------- ---------------------------- --------------------------------------- <br /> FINAL INSPECTION BY:._............ ..�?--_:..._................._..- Date__L- -/.—L..1.}.•r-..N..........................-............. <br /> ` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> v <br /> ES-9-2M 10-52 Revised W-2100 <br />