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APPLICATION FOR SANITATION PERMIT 3Permit No. m _ � - (Complete in Duplicate) Date Issued Application is hereby madelto 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. + JOB ADDRESS AND LOCATION-------rfl 1� ��4QI �Q�.._ i�4N ------------------------------------------------------------------------------------- t � � Owner's Name.--•-------- ... --------•- ]c c - --- .-- 1-�C.CA-RC O-�---------�----,- -------------------------------------------- Phone----ZZ.j--5� Address--- ------------------------------- �V5.. 4 �---' �'« � ? ----------------------•- / Contractor's Name----------------------•--•--._.PAMR11- �1---- ----------------------------------------------------------------: Phone----_C.-� C]Q------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- --_-_ Number of bedrooms Number of baths Lot size _-_ __-------------------- 3 Wafer Supply: Public system 5K Community system ❑ Private'❑' Depth to Water Table -------- ft. a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑SCJ f+p/p/Y)62 I7/�}R�l 1/i2sa;HAS 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-------- ----------------------------. --.---.--.p jt5't t`l+f No. of compartments------------ Size---------------------------------Liquid depth--------------------------`-Capacity-----------------------"�]` Disposal Field: Distance from nearest well__P.(A.N-fE._.Distance from foundation-/_�............Distance to nearest lot line_--- Number oil lines--------1-------------------------Length of each line—.70-—--------------Width of trench ------------------ Type os` filter material-----/------------------Depth of filter material_--/_g----°-------Total length-'_-_-_,Z9_Q'---------------------- Seepage Pit: Distance to nearest well_---------------------Distance from foundation--------------------Distance to nearest lot line----------------- jS r l Number of pits----------------------Lining material---------------------.Size: Diameter------------------------Depth------ -------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material------------------------------------- El Size: Diameter------ '------------------------------Depth-------------------------- -----------------------Liquid Capacity-----------------------------gals. F Distance from nearest building Privy: Distance from nearest well-------------------------------•------- ------ - g------------------------------------------- 11 --------- ----------------------=-------❑ Distance to nearest lot line.------ ------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe)=-------- ------------------------------------------------------------------------------------------------------I--------------------------------------- --------------------------------------------------------------•----------------------------------------------------- .... ------------------------------------------------------------------------------------------------ - ------------------------------------------------ --------------------------•------------------------------------------------------------------ --------------------------------------------------------------- I hereby certff at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lows,landitiules and regulations of the San Joaquin Local Health District. (Signed)----------------- --- - ---- --- ' ------------------------- -- ----- -------- ------ ------ Contractor) a r (Plot plan, showing size of lot, location of system in relat to wells, buildirs, efc., can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATEs.V-------------------------- -------------------------- REVIEWEDBY------------------------------- --------------`---------------------- ---- ---------------------------------------- DATE-- '%---------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--- , Alterations and/or recommendat-ssons-------- --------- -------- ---------------------------------------------------•------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- --- -------------------- ----------- ------------- ------ ------------------------------ FINAL INSPECTION BY:. -S-------------------- Date -- ------ ----I----------- --- SAN -------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 L