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APPLICATION FOR SANITATION PERMIT Permit-N i 4- (Complefe'in Duplicate) Date Issued � _ A liion is here y PP 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 AND LOCATION.. y" 12 ------- -----------------------------------•------------ ------ Owner's NameQ- _!C.__�j -.-o-�--- ------- Phone -^.e .. _ _- Address...---------------------------------------------2a,09 -e `: ------------------------------------------------------------------------------•--------------------------------- Contractor's Name------•--------••------ •-----f A14JM. 5.�--------------- ---------------------------------------- ------- Phone..---.. -`_ p °----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1--.-- Number of bedrooms _ Number of baths .-J- Lot size -__-.-- ---2--�-�-+rte.-�-------------------- Water Supply: Public system ❑ Community system ❑ Private gL Depth to Water Table .-f__0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe , Hardpan ❑ Previous Application Made: Yes ❑ No &, New Construction: Yes ❑ No ❑ `/t�<�•e%- TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Tank; Distance from nearest well-----------------Distance from foundation-------------_------Material---_----.-...------------..-_-_-.---......___. i No. of..compartments.--- •--------------------Size--------------- ----------------Liquid.depth--------------------------Capacity---------------------- isposal Field: Distance-from nearest well-----------------Distance from foundation-------_----------Distance to nearest lot line----------------- El Number of- lines---------------------------------I Length of each line--------------------- .------Width of•trench------------------------------ Type of filter material-------------------------Depth of filter material---.-------------.----Total length------------------------------------------ . Seepage Pit: Distance t nearest well../400--- Distance fr fo ndation--/P-----.Distance to nearest lot line---- - .... Number of pits.----� ------------Lining material -. -.-Size: Diameter_ ----------Depth..,L -----------------_---- y Cesspool: , 'a. Distance from nearest well----------------Distaa�nce from foundation--------------------Lining material--------.---- .-.-.---.--_-.- ❑ ------------------Liquid Capacity-- .-----------------------gals. Size: Diameter Depth Privy: Distance from nearest well ------------------------`_ : ------ --Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line--------- ------------------ --------------------------------------------------------------------------- ------------------------------------ Remodeling and/or)repairing (describe)----------------------------------- ---------f------------------- -------------------------- ------------------------------ ---- i --------=---- -` - ------= ----- -------- --•---------------------------------------------------------- -- -------------------------- ---------•-------------------------------- I hereby certify that I have prepared this application and +hat the work will-be done in accordance with San Joaquin County ordinances, St laws, and rule and regulations of the San Joaquin Local Health District. -.. �.'' - - - ---------- (O; �a Contractor) (Signed)---------- ---- B ----------(Title)------ � _;f114-,_----------------- Y•------------------------------------------------ -- f (Plot Plan, showing size of lot, location of system in re , ion to wells, building a+c., can be Placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYS --------------------------------- --------------------------•-------------------- DATE--. REVIEWEDBY------------------------------ DATE ----------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------- -------------------------- --------------------------------------- DATE------- ------------------------------------------------ Alterationsand/or recommendations:----------------------------- - ------------------------------------------------------------------••--------------------------------•---•--••------------------- ---•---------.-...--------------------------------------------------------------------------------- ------------ - -----•--------------------------------------------------------------------•----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------- ----------------------- ----- - - --------------------------------------------------------- ------- ---------- --- ----------------------------- ---------------- --- !/ AlIr, Date------------ �a -------- ----- --------------------- FINAL INSPECTION BY:.-.-------------- ---•------- - ----------------- 1 SAN JOAQU[N LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+ock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M io-52 Revised W-2100 fir