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APPLICATION FOR SANITATION PERMIT Permit No. ..............._. (Complete in Duplicate) Date Issued ____��_- S-s� Applica+ion 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 AND LOCATION----------------C` '�Tt y ..- - -- Owner's Name--------------'-------------lam.].......... �--t��'�? --------------------------- --------------------------------------------- Phone------------------------------------ Address --------------------------/------------------------------- --------------•---------------------------------•--••-----------------------------------------•-- Contractor's. Name-----'----------------------- t.7C -`•• -' -21L ------------------------------------------------------------ Phone----••-•----------------•---------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trail7r, Court E] Motel E] Other ❑ Number of living units: .:1-____ Number of bedrooms . -_ Number of baths _I_ _ Lot size ----------------------------- Water -__-_'____________________Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --------- ft. i 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ I -� Septic Tank: Distance from nearesr well �5;�____Distance from foundation____/�_________-Material-__.-___ �%�'_.-.,._________________ ci No. of compartment's Size -----Liquid depth--------- -----------Capacity.......2_,70_--'--- Disposal Field: Distance from nearest well _.1_�_--....Distance from foundation----- -�_ __.__.Distance to nearest lot line------- p Number of lines-----------------�--i---------Length of each line--------4�-�------------.Width of french-------____a-�� --------- Type of filter material-____._ll_i____________Depth of filter material___.__-��_..___-_--Total length_____________ '_ F -------------•-- f ( -. Seepage Pit: Distance to�nearest well-.-I-----------------Distance from foundation-_--_______....__-.Distance to nearest lot line- _________-__. "11 1 ❑' Number of pits. .Lining materiel Size: Diameter Depth \yt� � 7 \ ! Cesspool: D]stance from nearest well________--_:.___Distance from foundation--------------------Lining material------------- --------------------- ❑ Size.Diameter------------------ ------ -----------Depth------------------ --------- ---= -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--- -_ -_- -----_.�_-Dis t� from nearest building_--_---__._________________------------- . ❑ Distance to nearest lot line_."�"-I ------------------------- --------------------------------------------------- ----------------- -------------- --------------- Remo -- ------------- Remo ling and/or repairin (describe)- - _-----------_- ------- -�� - ----_- - -- --- ----------- ' : -------------------1 7, s-_---------------- _:__ --------------------- ------------ - ----------- I - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. J (Signed)_ ------------ -------- ------------..r------------------ -------------------- - _-_.____-------.(Owner and/or{Contractor) By: .-Y Cmc�t------ -��r' f{ " - - --- s•----------------------- " ----(Title)-------------- ' (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc.,kcan be placed on reverse side). f k. FOR DEPARTMENT USE ONLY ' --- DATE-------- --- --- APPLlCAT10N ACCEPTED BY ------------ - REVIEWEDBY------ ------=----------------------------------------------------------------------•- ---------- f DATE ---•-• =-----------------F-------------- BUILDING PERMIT ISSIIED-------`------------------� `�" --------- - ' - DATES -... '--------- E �'`�--------------- I' ------- Alter t' s and/or recommendations:------- - ---• ------- -- -- ---- - a "G -------- °------" ---= `""� --------- - d>,4'� .,� is - .:�`�.� = ° ,,,///JJJ SAA _ SOA TMiwJ�r.�- 4 ``i•`ufi�-___ �Eh � AWA 7u� ____t� :_ __ __ _ _. ________________•_.__.__ - --- ^ i0 ��.- ,3' _ .' Sig- -•-------------------------- FINAL INSPECTION BY::� ------------------ Date_...~_:_ - ►4 + - SAN JOAQUIN LOCAL'HEALTH DISTRICT' t � ; v 134 South American Street 300 Wes+ 044 Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--4=2M ":Revised W-2100