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APPLICATION FOR SANITATION PERMIT Permit No. _417Y.- [Complete in Duplicate] Date Issued ----- g }� Applica4ion 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 County Ordinance No. 549. i JOB ADDRESS AND LO GATT N------F`�--ZI-6-------------- � -rte;-...: = ------- Owner's Name------ -•-------- - --------- --------------- -------------------------------------------------------------------------------- ----- Phone------------------------------------ Address------ ............... - ----------- Contractor's Name---- - ` � rL�.!'�------- Z__1------------ Phone 0 __ _ _ Installation will serve: Residence JR Apartment House ❑ Commercial EM Trailer Court ❑ Mo+el ❑ Other ❑ 0 Number of living units: Number of bedrooms ---0_ Number of baths __/--- Litt size -----27 _ _f D --------------------- III Water Supply: Public system Community system [-I Private ❑ Depth to Water Table __�o ft. Character of soil to a depth of 3 feet: Sand E] Gravel L] Sandy Loam ElClay Lo m ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 70- New Construction: Yes ❑ No (� i i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank or cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest well-- Distance from foundation----��t;.-------Material--__ No. of compartments_._____ _ _ - -- Size__-_h__�P_- ._ GLigwd de`th_.-.--- ------____-_Ca�pacity..._..�rz�r__-- Disposal Field: Distance from nearest well-/& -1— Distance from foundation___-� -__--.__Distance to nearest lot line_/ ._..... Number of lines--------- ------ -r Length of each line-------- -3 :�--�f----.Width of trench----------W- - ------------- j Type of filter material----_..Y---- _:___'rJ&Pth of'filter material------ --�__-_Total length-------�O---------------- 1P __ l Seepage Pit: Distance to nearest well..../&8_z-�Distance from foundatigp____.� ___"..D�fance �o nearest lot line_____ �______ S .�iameterA r----.De to ------------ Number of pits------- Lining material _ ry E1. p Cesspool: Distance from nearest well-----------------Distance from foundation_.-___- ----_--..Lining material_______-___-----_-_-__------_-_.-- Size: Diameter___-:_._`-------------------^--______Dept h Liquid Capacity gals. . Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-_.____-_____--_------______-----.--_ ❑ . Distance to nearest lot line-------------------=------=------------------- --------------------- -------=--=------------------------------------------------------- 6 X Remodeling and/or repairing (describe):-------------------- i ----------=------------•-•------------•-------------------•- •----------•---------------------• ----•---------•--•-•----------------- ------------------••-----------------------------•----- ? --------------------------- ---------------------------------------------------------------------------------•----------------------------- --- -------------------•-----•------------------------- -------------- i Ir I hereby certirfy -I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State wss, Andrulesand regulations of the,San Joaquin Local Health Dis't`rict. _1 �— _________�'_______________ __ _______Owner and/or Contractor (Signed)---------------V---------- -------I-- i [ / ) By--'• - ' =�s -G- �------------- �[Title) rz (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., car, be' placed on reverse side). FOR DEPARTMENT USE ONLY 0 ,ff APPLICATION ACCEPTED BY--------------- -------------------- -- -----------------------------------�! DATE------ ' --j--��--L_ - ----------------- REVIEWEQ BY ----------' DATE ' BUILQING PERMIT ISSUED I( DATE---------------:--------------------------------------------- i -------------------- - - Alterations and/or recommendations:..--t------------------------------- ------ •--------------------------------''....---------------------------------•--••------------------------------ ------ ' --- ' ---------------------------------------------------------------------- V�-------- f ): -----------'------------------------- r --r---------- ------- w ---------------------------- ----------------- --------------------------------------------------------------------i------------------------------------------------------------•------------ FINAL INSPECTION 8Y:`'' = `5 = Date-----w---- -------�'--_------�------------------ ----------------=---- �N SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 - ES-9-2M Revised W-2100