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I e��.••c-� 10; 3 a a.,i l/:o o1 c ,—,,.APPLICATION FOR SANITATION PERMIT -4 Permit No.A2_-.9__p_ r7- I- o Z -- (Complete in Duplicate) Dat© Issued o� 7- /,s-1-is Application is hereby made to the San Joaquin Local Health District for a permit to con truct and ' stall the work herein16ed. This application is made in compliance with Cou y r inan No. 5 A �_0 3.S'Se t..A -A-r RA.-CH Atl. JOB ADDRESS AND LOCATION.. ..._ -.. _-. _. It_• Owner's N � ti - P one. tS_Qs Address Contractor's Name........... ... 1 __ .._.-..- .r-.._. Phone---7 �_A Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of livin 9 units: Number of bedrooms.Number of baths ----- Lot size19f1 Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe Hardpan❑� .Previous Application Made: Yes El 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 nearest well._..--_--_:_ Distance from foundation_...................Material.......... El ........................ . -----•----- No. of compartments.. Size..............................._Liquid depth..__-------- .-............Capacity.....................-_ � Dis o I Field: Distance from nearest well Distance from foundefion_f .. ��-••-•- �---.....Distance to nearest lot ine./,e._.....__ 09 Number of lines....&r1..,...__. Length ofeachline...e„�r ` Width of trench_ Type of filter material-..�,tCl. _-__--Depth of filter material....l . . Total length. --------- - .............. Se a Pit: Distance to nearest well --__-Distance m f9 dation .___.._.Distance to nearest I line../p-_ Number of pits_.Q -.:.__Lining meterial._ 4.t,i^ $ize: Diameter._ .....Depth_ .5 r h Cesspool: Distance from nearest well...-------.......D'+stance from foundation-.__..___---_-_._:.Lining material-------_.............................. (` ❑ Size: Diameter-----------......_-------------__Depth...........................---....----------•-.---._Liquid Capacity..-- ---------------------gals Privy: Distarce From nearest well__._....---___............................__Distance from nearest building ❑ Distance to nearest lot line----.-----•-...----� - ............... -...............................--- -•---•...... Remodeling and/or repairing (describej:_._,..1,�. .1_. ._ �- ' --- --- 'TcL --------- ---------------- ... .. -----------••-•--------•-------------..........................--------------------------------------•------------..............................---------.................-.........-----•.........------• �. I hereby ce y hat I have pr red this application and that the work will be done in accordance with San Joaquin County, ordinances, St (a app rules an regulations o the S Joaqui 1,Health District. (Signed)._.. - -• - - -�-�---- -- -.(Owneh andjo. Con ae+or) By:................ -(Title) -- (Plot plan. showing si ot, location of system in relation o wells, buildings, ere., can be platp1d .-nreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ......._... -- DATE.... _ REVIEWED BY............... �, .._._._.-..-...__..r- -------- _--- ..... _.._-------------- ._-.__-. DATE.:._..•- • ""►i3 BUILDING PERMIT ISSUED............ ... ... ... .. . --.------•--••- -----------------.......... .....------•---- DATE.. A+erations and/or recommendations:...................... •------..-...-----............-•-----------------'-•--••••••"""-....._.._._.._..'.----•---\----_..•--'•'-•-'•-- ----------------------•----...._..__.....-...__._...--.................•---••-•----•-•-..----••--•-..._.--------•...-•---- -.......................................•-•----......._.__.............................................................................. --------------- --------- ..................... FINAL INSPECTION BY: -- ---- ...._.•.,. _. Date. ..,. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 132 Sycamore Street 814 North "C"Strout Stockton, California Lodi, California Manteca, California Teaey, California ES-9-2M 8.51 Revised W-2100