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i APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 County Ordinance No. 549. lo t'f �� , � 5'#� G � 'IE _C�f�l ------ JOB ADDRESS AND LOCATION----------�-8.0 f--- �l- �}" r� I fa 8_�_l14----- - - -•j- I Owner's Name-------------------------------------------- ..:-.-- -------- Phone-- �°17-e------ Address--------------------------------------- { Contractor's Name---------------------•------- ._ .r_�C'- -i _ -------50---M-----f 'G -�----- Phone �1- Installation will serve: Residence X Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms j---- Number of baths __/-- Lot size _--sQ -_-----_--_--10------------------ Water Supply: Public system ❑ Community system '❑ Private jK Depth to Water Tablev-2X70ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑�k Previous Application Made: Yes ❑ Nojj?�_ New Construction: Yes g 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 weILQ___----_Distance from foundation `� ---.Material-a - — ,gyp _ ---pp------------- No.% of compartments_�s____-_.__-- _--,----Siz e r'Xa+a`+ ��Liquid depth__4��_"----------Capacity...P-�Zfel __- .� Disposal Field: Distance from nearest wel€__ E ----_Distance from foundation�q- _-----Distance to nearest lot line__-_---'e3_----.., ( Number of lines-_-_ Z_______________________Length of each line----i�d'--1 _'__"Width of trench___._�'S�-----_-_-_----- ,� '1 •'------Total length-----��- ,---------------- Type of filter matena{--�_,rt_ _��____-Depth ,of filter material-____f"�-_-_- Seepage Pit: Distance to nearest well----------------------Distance from foundation_________---____-__Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size. Diameter------------------------Depth-_------------------____--------- Cesspool: Distance from nearest well_________________Distance from foundation----------------_--.Lining material----_-----_----_--__----_-----__--_-_. ❑ Size: Diameter------------------------- ---- -------Depth---------------------------------------------------Liquid Capacity----------------------------g Privy: Distance from nearest well-----------------_----______-------------,---_Distance from nearest building_-_-__------__-__-__---___-_-___--------. ❑ Distance to nearest lot line------ ------------------------------------------------------------•------------- ---------------------------------------------------------- Remodeling and/or repairing (describe)------------------------- ` � -- _ ------- lttL,,t- .�'U /rGd1----------,------------------------------------------------------------------- s -----------------------------------------------•------------- -----------------•--------------------------•-------------------•-------------------------------------------------------------------------------------------- I hereby certify that I have 'ad pared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and ru es ' regulations of n Joaquin Local Health District. (Signed)---- 'h�� " �''�=s� - ------------------ --------( Contractor) 1 B . --- - ---- (Title)---,, �. -- T� } r_"CI7 ! (Piot pla , showin of lot, location of syst7eiin relafiion to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------" -- I -- - DATE REVIEWEDBY--------------------------------- ` "! _ ---------------- - --- DATE "--. f- �,,� ---- BUILDING PERMIT ISSUED------------ __ I-� - > ----------------------------------------------- DATE-------------------- -� Alterationsand/or recommendations---------------------------------------------- -------------------------- ----------------- --------------------------------------------------------------- -------------------- -----•------------------------•------•---------------•------------•----- --------------------------- ------------•---------------------------------------------------------•---------------------------------------------•- ----------------------------------------------------------------------------------------------------•---------------------•----------------------------------------- ----------------------•---------------------------------- FINAL INSPECTION BY:------ )-v- --------------- Date--------Ly ; "�-4` --- ----------- 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-9--2M 8-51 Revised W-2100