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S, APPLICATION FOR, 77 SANITATION PERMIT Permit No i�q (Complete in Duplicate) Date Issued X,� Applicafio is he aby made to the San Joaquin Local Health District for a permif to construct.and install the work herein described. This application is made in compliance with Countyrdinance No 549 q.... ............. -------------------------------------------------4- # --------------- JOB ADDRESS A 0 `-Z q Owner's Namp_ . - - ---I------ ---------------------------------------------------------------------------------.__ Phone ---- ---Address - 6 --d-1-------/0 ---------- -------------- -- -- ----- -------------------------------------------I—----------------------------------------------------------- ------------- Contractor's Name--- ---- ------- ---- --- ------------------------------------------------------------------------------------------------ Phone----------------- Installation will serve- Residence Apartment House F] Commercial El Trailer Court I ------------------- Number of living units: umber of bedrooms VIM;o/tp El Other 0 ii Water Supply: Public -------- Number of baths h0 Lot size --- ----------------------- system EEecommunify system E] Private 0 Depth to Water Table -------- ft. Character of.soil to a depth of 3 feet- Sand El Gravel E] Sandy Loam Clay Loam E] Previous Application Made: Y '*/Ej New Construction Y Clay El Adobe 0--Hardpan [j ci� Yes ; EJ 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-__ ---------------------------------------- No. of compartments-------------- -----------Size------------- -----------•-----•Liquid depth--------------------------- -----Capacity---,------------------- Dispo I.Fi, Distance from nearest well------------------Distance from foundation------------------".Distance to nearest lot line._______--- Number of lines----------- 1� ------------------------Length of each line-----_----------------------_.width of french Type of filter material______________ I D p�ho��TferjalTotal length. Pit: --------------------------------;------- a ou N, Distance to nearest will-1-00 ou Di -est lot'I in f�r.n .7 a or f e to new e 05 4- Seev Number of pits,---------- f ---------- iz D-i-a------6 -------------- ------x-___Xn*ng mate i --------- ---------- Diam, r--- er-------9�------Depth------t Cesspool: Distance from nearest well_-_----_-.--___ Dist ce from fou ion--------------------Lining Lining material____---_____-----_--_-_____ ❑ Size. Diameter--- I ----------- I --------------------Depth-----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_"-_""-__"_"____-_"_"_-t'ce to nearest ]of line______""-- --------------------------Distance from nearest building------------------------•---------- Distance ---------------------------------------------------------------------------- ---------1-1------------------------------------------- Remode d 11 9-and/ -- -•-------------------_-- or -repairing (clesc4e):__W_ ,_t-------�, _.;r ------------------- - --- -- --------------------_------------------------------------71_�--------------------------- ------------ -- -------- ....... . .......... ----------------------------------------------------------- ------ V-------------- --- -------------- ----- ------------ ------------------------------------- --------------------- -------------------------------------------- ----------------------------- -- -----un --- an Joaquin ............... ........ _ --Co- I hereby certify that I have prepared--------------------------------------------------------------------*-------------------------------------------------- -- ---------------- ill be done in accordance ordinances, State laws, and rules,and--regulations of the San Joaquin Local Health District. (Signed).. --------------------------------------------------------------------------------------(Owner and/or Contractor) By:----------------------------------------------------------------- (Title) ------------------------------------------------------------------------(Plot -- plan, showing-size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By(_�� ----- ------------------------------ ----------------------------------------------------- DATE REVIEWEDBY -1-- -- ------------------------------------------------- BUILDING PERM ------------ DATC�_E_7_ IT ISSUE ... �;�_11---------------------------------------------- ------------ -------------------------------------------------------------------------------- DATE--------- Alterations and/or recommendations:"______________________ ---------------------1 ------------------••------- ------------------•--•-------•-------- --------------------- ----------------------------- --------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------I -------------------------------------------------------------------------------------------------------------.......--------------- i -------------------------------------------------------------------------------------------------------------------•------------ I -------- I---------- ---------- ----------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---- ----------------------------------------- Date_ f- --------------- --- -------------------I----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ,Stockton, California L*dr, California Man+*ca, CaliforniaTracy. California ES-9-2M 8-51 Revised W-2100