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APPLICATION FOR SANITATION PERMIT Permit No. . _ _....-- (Complete in Duplicate) �l -s 1- Date Issued Applica4ion 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. JOB ADDRESS A D L CATIONf-�-- �0'-war----Q�_�f__��'��24�(�f_�_e�_[.�e,go/P---e---_l d�?_P--------�- -Zr-ol�c1 O� Owner's Name �� ef----lu.!_. --i -`--- .... Phone ----' �_ s __ Address G,l'� °f_ �°_l' �' -� f/lZ i'� p_ I_. !�!/.5 _(�A •---------------- --- ... � _ _s�- ,1�.1 =�1I --(.saw r------ 10 Contractor's Name------ ----- ✓.---------------------------------------------------------•------------------•-----.-. Phone- 11--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other [N,r—a: Number of living units-- -------- Number of bedrooms -------- Number of baths -��_ Lot size ---- ...... Water Supply: Public system 'E3 Community system ❑ Private X Depth to Water Tablet.4- Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam ElClay Loam E] Clay ❑ Adobe j Hardpan E] Previous Application Made: Yes ❑ No X New Construction: Yes Od 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 wel1�-�_�---Distance from foundation_Ja...__._.._.Material---_ l No. of compartmens_9___________________ Liquid depth_-� .�....___..__Capacity---- " o "- Disposal Field: Distance from nea�st well_________________Distance from foundation__ -____-__.-._..._.Distance to nearest lot line_-- Number of lines___ ______.._____________________Length of each line--'---,fO_`__aa_________-Width of trench__-e�_�____._--_-----___---- Type of filter material--1Y2 RK-_.---Depth of filter mate rial_____ll�--��;. -__Total length_-_�P---------------------- Seepage Pit: Distance to nearest well f --_-_---Distance fro foundation___?�'__...___'.D/istan ce to nearest lot line________________ ■ Number of pits______ ______________Lining material-��dk----Size- Diameter-_ -vaVI---.Depth._- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material------------------------------------- El Size: Diameter--------------------------------- Depth--------------------------- - ------ -- Licluid Capacity gals' . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_____-_._-.-------__----___-_--_____.I ❑ Distance to nearest lot line---------------- ------------------------------ --------------------•----------------------------------------------------------------------- Remodeling and/or repairing (describe) "----c-s?-----`1" e3/44-1--- .-12,------F7 -----•-••--•------------- ------------••---------------------------------------------------------------- -._.--.`.-S-------------------------------------------------- ------------------------------------------- ") •----------------------------------------------------------------------------------------------•------•--------------------`--------------------•----- -----------------------------...-...-•--------------------- ----.. ------------------------------------=----------------•------------�---------------------------------------- ------------------------ I I hereby ce if that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, StNj S. and rule and gulations of the San Joaquin Local Health District. (SSigned '1.' -------------- ------- ------------ - ar Contractor) igned' By:-------------------------------- - --- _ (Title)------------%---I aT6�!--------------------- (Plot plan, showing size of lot, location of system in relatio to wells, buildings, ell— can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- �------------------------------------ iS DATE •'S ` 6 REVIEWEDBY--------------------------------- ------------------------------------------------- - ---------------------------------------- DATE----------------------- ------------------------•------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or.recommendations:------------------------------------------------------------------------------------------------------•---------------• ••---•-•----...... -------- ------------------•----------------•-------------•--------------------------------- ------------------- ----------•------------------ -------------•----------------------------------------------------------------------- ----------------------------- ---------------------------- ----------------------------•---------------------- --------------------•-••----- ------ ----------•-------------- ----------------------------------------------- -------------------- FINALINSPECTION BY------------------ __ I ---------- Date---------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M Revised W-2100 i