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APPLICATION FOR SANITATION PERMIT Permit No. �_6_3..iP (Complete in Duplicate) Date Issued Application is 'hereby mal to the San Joaquin Local Health District for 1 pert to construct and install the work herein described. This application is made incompliance with County Ordinance No. JOB ADDRESS AND LOCATION------------ ----------- !F? ------- Owner's Name-------------_ ---•---•-AAhil ---------------------------------------------a k ------------ -------- Phone-----------•• --------------------- Address.-.--... ------------------------------------------------------------------------------ - Contractor's Name..----•---•--•-------•_-oi------------- ------------------------------------------------------------------------------- Phone----•--•------ --==--------------- Installation will serve: R sidencea Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 9 Of her ❑ 'rt ! Number of living units: -------- Number of bedrooms .--.- Number of baths ._....-. Lot size --------A ----........... ------ Water Supply: Public system ❑ Community system ❑ PrivateDepth ,to Water Table Q_ ft. Character of soil to a depth of 34eet: Sand ❑ Gravel El Sandy ❑� Clay Foam [] Clay ❑ Adobe Hardpan.❑ Previous Application Made: Yes ❑ NoNew Construction: Yes No � T-4 TYPE OF INSTALLATION AND IPECIFI' El (No septic tank or cesspoof permitted if public sewer is available within 200 feet.) ; i Septic Tank: Distance from nearest well----- -----Distance from foundation.....--T4-------Material--------Re-f, .-ice - ...-►_____...------ + '.t i• N o. of c6'm a rtments --- ------•2_. Size._ A'11 ----- �d (� � _ �_ .__�-�`�.X-.�___Liquid d�h--_pistance to nearest lot line � Disposal Field:: Distance frck.nearest well-....54.-----.Distance from foundation------� ._....- Number of lines-----------2.y- -1�...__- ------Length of each line-------��------ -----.Width of trench.--------2 T'�--------------- Type or-filter material..�X.___-P4----Depth of filter material---------/ ._........Total length.._..._ ..__..x..---7.4.' L Seepage Pit: Distance to-nearest well____------------------Distance from foundation.............:......Distance to nearest loo line----.--..._...-.- ❑ Number",,,of Iipits----------------------Luring material-----------------------Size: Diameter----------------- Depth Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining ❑ f material- -.-_-----.----------------.-_ -_--.- Size: Diameter-1 Depth---- Liquid Capacity----------------------------gals .- Privy: Distance from nearest well------------------------------------- ---------Distance from nearest building-------------------------------.- ----__ ❑ Distance to nearest lot liner______________________`- , yy ----------------------'-----------------------'----------._-_.------'------------------"--------------�----r�----�- 0 gP ;describe ------------------------------------ -----•------------------••------------------------------------- _ ` Nom•---�y �- ------ --------------M-- ---------/' ' �' =----------=------------- -- - A---------- emo e m and/or repairing ------------- ------'k-------------------- ` #�_ ---4-1-S -----------0a r*--------&�a4----------------------------------------------------:------ _____ 1 hereby certify that I have prepared this application and that the w6rk7will,be done in accordance with San Joaquin County ordinances, State laws, and rules amend`re�ulafionsofSan Joaquin Local Health District. • � ---Owner and or Contratfor(Signed)•---.� �. .. --- ---- -------�------------------- ------:----------------------------�----------------------------------- ----- { / I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s c r FOR DEPARTMENT USE ONLY , a 5 6 APPLICATION ACCEPTED BY--- ------------------- -- .. = DATE ---------- "?4- :75-3REVIEWED BY-----------i--------------- - --------------------------------------------------� ... . BUILDINGPERMIT ISSUED------- ---------------------------------------------------------------------------------------------- DATE------ --------------•-------------------------------- Alterations and/or recommendations------ ------- 1'-- -------------- ---------- I-----------------------------•---------- ------------------ - ---------------------- -------------------------------------- } _ ^ �: - ......RC1 - { .Y ?� ---------------- -I&/-----ra'� -------- ------- � �^sT - j ------- -------------------------------------------------------------------- ----- " ------------------------=------------ ----------------------------------`---- -------- -------------- ------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY--------------------------- --- -------..-.-- - ------------------- Date_..._........ / 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-4-2M 10-52 Revised W-2100