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APPLICATION FOR SANITATION PERMIT Permit No. J _✓-- _____:__ (Complete in Duplicate) w� .. .Date:,Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permif to construct and install the work herein described. ' This application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATION............. _7 tf-------C._Uv G l •,--------"------f '-------------' ------------ Owner's Name =--------•-�`- -" --- G R = �3 . _&17 -• --------;--- --- Phone.- ------ Address- -------•-•--- 2 T Srf;�G""`/ �----/tJ Contractor's Name---------------•----------------------------------------------• ------- ---t--------------- ---------------------------------------------- Phone--------•---•-•-------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ . Trailer Court ❑' Motel ❑ Other ❑ Number of living. units: _/Con�munity umber of bedrooms ____/._ Number of baths ___�.__ Lot size -____V�l�_x_��U----�S�`�/�--- Water Su I Public sastem s stem Private De th to Water Table ______._ ft. ' Pp Y� Y Y ❑ ❑ p _ Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ -Sandy Loam [7 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes 0 No ❑ New Construction: Yes 9-- N' El TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank for cesspool permitted if public sewer is available within 200 feet.) _ - s /` Septic Tank: Distance from nearest well___ -. ' isfance from foundation___-_/6........ Mat rial�__ ___ i No' of compartments--------- ---- ^- Size---.��?._ C_/_ _` ,=_Liquid depih.-------- -------CapacitY------ -d----• Dispos Field: Distance from nearest well_._.<I��-�Distance from foundation_____ .......Distance to nearest lot line-------- - ------------------Length.of each linea_-5:' 'x'_64 PWidth of french___-____._�4�._:_________ Number o{ lines_________ . Type of filter,material `.-___._____Depth of filter material-------- .��___ Total length---------------Lld__'____________- 1 . . �� Seepage Pit: Distance to nearest well-.______.______.___Distance from foundation____--..--_ -___-.Distance to nearest lot line----------------- ❑ Number of pits-------- il ----------Lining material-----------------------Size: Diameter.._---- ----------------Depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- ._ El Diameter--------------------------- ----Depth Liquid Capacity gals. Privy: Distance from nearest well --------------------------------------Distance from nearest building_____________._,_-__________-..,-_-----_. ❑ t Distance to nearest lot line------------------- ------------t---------------==----------------------------•------------------------------------ t Remodeling and/or repairing (describe):--------- `----------------•-------------------------------------------------------=-------••----------'-------------•----•-------------------•------- i ----------------------------------------- -------------•----------------...-----------•-------------------------------- --------------------•----------------------------------••-----•------------- ------------------- ---------------------- --------------6---------------------------- -----------:---- = ••-•--••-------- --•-------------------------- ---------------•--------------------------------------------------------•---------------------- I hereby certify that 1 have prepared this applicafion and'that the work will be done in'accordance with'San Joaquin 'County ordinances, Sta�e law's•; and rules and regulations of the San Joaquin Local Health District. b •. f`------- (Signed) ` = towner and/or Contractor) --------•------------------• t Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- . _---�- - -- DATE----------------- -- --- - -------------- DATE .------____-- r REVIEWEDBY----------------------------------------- --�------------------ --------- - ----------------- BUILDING -------- •- •--- DATE-----------•------------------ •--.....-------------------- BUILDINGPERMIT ISSUED------------------IJ---------------------------------------------------------- --------------------- DATE---------------------------------------------------------- Alterations and/or recommendations:-- -------------- = ---------------------------------'- ------ -n------- '-----•---- ------ -•--_------` ------ 1-`z'r " 's.._1 _.�.r . _ ._ f � ------�. a�= -- -:--- -- �f -- �- .. = - __9------------- � --- - °7-�---- --- - ---- _ ------ FINAL INSPECTIOWBY:..._ ,,, ------------------------------- ----- Date--------. ----------- ----± ' SAN JOAQUIN LOCAL HEALTH DISTRICT l _ 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California F . ES-9-2M Revised W-2100