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APPLICATION FOR SANITATION PERMIT Permit No. ------ _ -�,75 _ (Complete in Duplicate) } l ' Date Issued 0 � - A plication is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �F} JOB ADDRESS AND LOCATION----- - � -`-- `-'--6--------- � --------------Oa ---A-46-71'e.---- Owner's Name �1 �- Y-wI -------4!:;1016 Allff------------------------=------------------ Phone---Z/-��- ------ p '`. Address---------••-------------O.Zl---------W---•--o oi-f---------------------------------------------•--•---•-------------------------------------------•-------------------------------- Contractor's Name---------------------vwi1 (--------------•---------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---F---- Number of bedrooms -.2— Number of baths _____I. Lot size ----------/_�___�_-1,1.0--------------- Water Supply: Public system ❑ Community system ❑ Private.V Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ['V Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes V 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 welli___-EZ>____Distan from foundation____�_O_____._.Material______-�nc)(,,C_____L`___ No. of compartments ____ 'Ca acit "- �- v _ t q p � p� Y-------- Disposal - ----- -� p - - -- -------Size------ - -- - --�------Liquid id depth =- --=------ p .2_�_______Distance to nearest lot line__ ____ ____ Dis osal Field: Distance from nearest w I___ _._��-__.Distance from foundation___ Number of fines__________ - Length of each line_______ -- - ----_ -- - -�-0---- -- Width of french------r--�-�r�,p--------------------' Type of filter material __.__ ._Depth of filter material--------.l�_-------Total length---------12-, �'•_____________________ Seepage Pit: Distance to nearest well----------- -_--Distance from foundation--------------------Distance to nearest lot line___________.____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- 1 - Cesspool: Distance from nearest well----------------- from foundation--------------------Lining m,�terial-----------._____---___-_---_________ ❑ Size: Diameter------------------ -------------------Depth-------------------------------------------- -------Liquid Capacity----------------------------gals. Privy:. Distance fromnearest well_______________________________________________Distance from nearest building---------------------------_------------- F-1Distanceto nearest}lot-line _____________ ________________ remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------•------------------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------•----------------------------------------•-----------------------------------------•---------------------------------- I hereby certify that I have prepar this application and that the work will be done in accordance with San Joaquin County ordinances, State aw nd rules an gulations of the San Joaquin Local Health District. (Signed) -- ----- ---------------------------------------------------------------<Owne and/or Contractor i B (Tale)_ (Plot plan, showing size of lot, location o system in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY § APPLICATION ACCEPTED BY--------- ------ -- -------- ------------ --- DATE---------fs-- ---2- --� REVIEWEDBY-------------------------------------- -------------- - ----- ---- ----------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------- --------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-----------------------------•----------- ------------------ -----------------------------------------------------•----------------•------------------ ------------------------------------------------------------------------------------------- ------ -----------------•--------•--------------------------------------------------- -------------------------------------- ----------------------------------------------------------------------•---------- -------------•--------------- --------------- ------- ---------•-•--------------------------•---------------------------------------- (j FINAL INSPECTION BY------------------- ! ' ` Date------------------ / ? s ` . ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" S+reef Stockton, California Lodi, California Manteca, California Tracy, California i 8-9-2M B-51 Revised W-2100