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APPLICATION FOR SANITATION PERMIT Permit No --77_ (Complete in Duplicate) ,S Date Issued _ ^______I Applicaa•ion is hereby made to the San Joaquin Local Health District for a permit to construct and ins all the work herein described. 1 This application is made incompliance..with County Ordinance No. 549�. JOB ADDRESS Ao �-_` .. -- -- -- �_e- --------- -C7- -.AddOwner's Name------ - �_ - -- - -----------• ••--------------•------- ------------------ ----------------------- Address---------------_------- ress---------------_------- -" � � ----------------------------------------------------Phone. -------- --.. ._-.- Contractor's Name---- =-----------• Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [4 2,J2� U Number of living units: ________ Number of bedrooms -------- Number of baths�_�_____ Lot size ----�_2.��_� _l?--r-_ _�� " Water Supply. Publics stem .,�/Communit system Private Depth to Water Table ________ ft. PP Y� 5 Y IId' Y Y ❑ ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑"-Clay Loam ❑ Clay ❑ Ado Hardpan ❑' _ Previous Application Made:•Yes ❑ No New Construction: Yes ❑ No ❑ �, A TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank- Distance from nearest well-----------------Distance from foundation--------------------Material----------____-__-_--__------___-_-_-.__________- No. of.compartments--------------------------Size-------------------------- ---Liquid depth----------------- --------Capacity--- -------------- l3 osalF;iqd: Distance from nearest wellJ.6_1B__._Distance-from foundation___L_Q`____.-.Distance to nearest lot line---/Q------ Number of lines---�_�----------------------------Length of each line____�,�f--' - of trench._�i_�_ ----------------- 4- Type of filter material---1Y2�,`_0C-k.___'Depth of filter material----/_9' _Total length----/442_ ______________________ Seepage Pit: Distance to nearest well__-------------------Distance from foundation_ ---------_.-..Distance to nearest lot"line______!______.__ 1 ❑ Number of pits-----{-s_____;-__---_Lining material----------------------Size: Diameter------------------------ Cesspool: _ Distance from nearest well__________,__Distance from foundation-----------------_.Lining material Depth__---____----_-_-_--_--------------------------- El. ___---__ ❑ -� - Size: Diameter- :-_-__.._---------- Depth __-____Liquid Capacity Y =" gals. Privy: Distance from nearest well _______________--__-_____-_____._---___--'-_Distance from nearest building-------------.________________-___.______ 1 ❑ - Distance to nearest;lot'line-"`-_ ---- :.- 4 .,...,... .. ,_.._.t,.- .- - ------------ ------------------------ ----------- -------------------------------------------- FE � �� r Remodeling and/or repairing (describe�:___ '�---�------ -- -------- -- ----- �- _�<�-�-s.3-.---._z��-��•sr_.----------------••-----• --A— � �-;- ------------------------- ------------------------------------------------------- ' -------- -------------------------------------------------------------------------------------------..._.--•----=----------------------------------------------------------------.-.--------------------- ----------------------------------------- ------------------------------------- -------------------------------------------------------------------•------------...------------------------------------------------------ ,Y I:hereby ce ify that l have jareguflati, ed his pplication and that the work will be done in accordance with San-Joaquin County" ordinances, at laws," and les s he San Joaquin Local Health District. (Signed)....--- -----" ----- - --------------- --------- rgs, ------------------------ ----(� _ Contractor) ------ i t + r By: -------------------------- ------ :(Title) s l'Y _ _, ./'' (Plot plan, showing size of lot, location of system m relation to wells, buildc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY S APPLICATION ACCEPTED BY------------------- - ------------------------------------------------------------------ DATE-------/f/`.-_6-- - -------- -- REVIEWED BY-------------------------------------------- ------------------------------------------------------ DATE------------------------------------ ----------------------- BU I LDI NG PERMIT ISSUED----------------------------------- -- ---------------------------------------------------------- DATE------------------------------------------------- ---------- Alterations and/or recommendations-----------------------------------------------------------........---------------------------------------------------------•---------------------.._.._--------- s -•-----•-•••-------------------•---•-•---•---------------------•-'-i------•- ------------------------- -------- -------------------•----------------------------------------------------------------------------•-----------------------------------•------------------ -------------------•------•-------------------------------- •------ ---------- ---------------------•---------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------- ---- s 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-9-2M Revised W-2100