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AP tv V 1 1 i " PLICATION FOR SANITATION PERMIT Permt No, 4"- (Complete in Duplicate) --- --- 1 ------ Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Courity Ordinance No. 549,. JOB ADDRESS"AND mot LOCATfON ....-,'/-5--10 -------------------- ILAP-E.......--------------------------------------------------------------------------- Owne.r'i Name--------__-17-07-1-V vlu— ` , - --- - -----------------------------------------r...... ......... Address---- ............................ Phonej��--------- . .........-4A--- ------- ---- ------- - ----------------------------------------------------------------I---------------------------------------------------------- Contractor's Name--- ------ -- ----------- ------ - --- • -----r --------R-e1%4;!!;,e........................................ ... .. Phone--"/904o24 ----------------------------- Installation will serve: Residence W Apartment House E] Commercial El Trailer Court ❑ Motel E] Other D Number of living units: Number of bedrooms Number.of baths -/-- Lot size ____4/F -'X Water Supply: Public system Community system E] Private F] Depth to Wafer Table$".-,0- ft. Character of soil to a depth of 3 feet: Sand [:] Gravel E] Sandy Loam E] Clay Loam El Clay [I Aclob Previous Application Made: Yes E] 'No y New Construction: YesX No ❑ Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-194AI Distance from foundation-Z44?.........Materia� No. of compartments---------- ---Size. ---Liquid depth---!y - r;Capacity._ rr Disposal Field- Distance from nearest welJMPAKE...Distance from foundation--1-------------Distance to nearest )of line------- 3 i;� Number o-i' lines--- . 0 -----/----------------Length of each line________alip Width of french-------;L--v-------------------- Type of filter maferial-.1,J?,0j:AC-----Depth of filter material------ -.--_----Total length------- -------------------------- Seepage Pit: Distance to nearest well- -NAN-f---Distance from founclation--19-v..........Distance to nearest lot line---, Number of pits------,---------------Lining materialDiameter__...- -3-4) - ----- Depth----- 4.Size: D ia mete r�,-/o Cesspool: from nearest wellfoundation:_.________.______ - --------- ---------------------- Distance f, --Distance from❑ Lining material-------Diameter-------------------------------------Depth--------------------- - ----------------- ------------------------------Liquid Capacity------------ =.gals. Privy: Distance from nearest well______________________--_--_----- I from nearest building----------- I - ---------- Distance E❑ Distance to nearest Jot 1ine--------- Remodelingand/or repairing (describe)---------------------_---_I-----------I-----------------------I--------I-------------------------------------------------------------------------- ---------------------------- -------------------- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ I hereby certify that I 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 Loca]'Healfh District. {Signed)---------i ------ ---------- ---------- -------------------------------------------------------------- ----(C!K ver and/or Confracfo 47—-------------------------------------------------- By:----. ------- -400 (Title)- (Plot plan, showing size of lot, location/4 system in relation to wells, buildings, efc., can be placed j OR EP NT USE ONLY APPLICATION ACCEPTED BY-------------- ---------- ------------------------------------------ DATE.......... 0, REVIEWED BY ......-IP7�—:s BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ --------- DATE- --------------------------------------------------------------------------------------- Alterations and/or recommendations:. ------------------------------ - ----------- -------------------------------I—------------------------------------------------------------------------------------------------------------ OR EP NT USE :D Y---------------- .... .. ........ . .... ......... .... .... .......... ... ... �E ONLY ......... --------------------------------------------------- ----------------------------- ----------- --------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------- ------------------ ----------------------- --------------------------------------------- --------------------------------------- -------------------------------- ------------------------ ------------------------ -------- -- -----------------------------------------------------------------------L --------------- - ------- -------------- .............. Date------- FINAL INSPECTION BY______________ ------------- ------- -q.. --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streof 300 West Oak Street 132 Sycamore Street Stockton, California $14 North "C" Street Lodi, California Manteca, California Tracy, California E5-9-2M 10-52 Revised W-2100