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t' APPLICATION FOR SANITATION PERMIT Permit No. _S__G---- (Complete in Duplicate) Date Issued 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./f r /S S v JOB ADDRESS AND LOCATION---------- -------------- ----------- --------/ll'----------------------------------------- Owner's Name------- =------� {. L---�----- -------------- ---------------------------------------------- Phone------------------------------------ Address ��1 ` -----------a ''��E.x sr+-�... ----- Contractor's Name--- -_ ��._------�__-- Phone-l✓ ___ -- t�7_-- Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other ❑ Number of living units: ___� Number of bedrooms _�4�Number of baths ___I___ Lot size -- _."f _-._.X_/__62-------------------------- Wafer ____________________ ____Wafer Supply: -Public system 'Q Community system ❑ Private ❑ Depth to Water Table is� ft. _ Character of soil to a depth of 3 feet: Sand ❑. "Gravel I:1 . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0\ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No EN TYPE OF INSTALLATION AND SPECIFICATIONS: ' jNo se tic tank or cesspool permitted if public swer is available within 200 feet. Distance from nearesr well__ o I a -Distance from fFundation----_�o--..-_.__Mat'erialrT --------------- -- -s=s r% t - No. of compartments--------- � -.____- -Liquid dePth__.____ CaPoticy...... _ Disposal rr Y Fie9d: Distance from nearest well___ Distance from foundation--_-1 ___ --___...Distance to nearest lot line- ------------- Number of`lines-----'___" _______ ________ __Length of each line--------- r Width of trench----- _-`f___._.__._- Type of filter material--_ Depth of filter material----- --------Total length------Z_f�--------------------------- • Seepage Pit: "Distance to nearest well----_..:_.______:-Distance from foundation--------------------Distance'to nearest ]of line-------Number of pits----------------------Lining material-----------------------Size: Diameter----•---------------__-.Depth----------------------------•_--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----_____----.-----.----___--_------ ti ❑ Size: Diameter---------- ------------Depth-------- =-----=""- ---------------------------LiquidCapacity--------------------- ......gals. . Privy:l Distance from nearest well _.______~-------------_-----.---.-------___.__Distance from nearest building---_---_-_.--_--------_-------.----__----. ❑ Distance to nearest lot line.--- ------------------------------------------ Remodeling --------------------- ----------------Remodeling and/or repai n ��y� -- ........,.. s. � h °r �__... ------------- --- „ - ' _ u - --------------------------------- -"-'-----•------------------------------------------------------------------------------------•--------------------------------------------------------•---------------------------... 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, a d rules and regulations of the San Joaquin Local Health District. ' Y.-- -- -------�------- � __[Owner and/or Contcac+orl(Signed) - /r( -- --- -- --------- Y.--`_" .------ � - ----------------------(Title 1 ------------------------ (Piot plan, showing size of_lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE ONLY APPLICATIONBY_ -------- --- - -- ------------------------------------------------------------ REVIEWED ---- DATE . -- -- - - BY------------------------------- ---- - ------------------------------------------------------------------------------ DATE-- BUILDING PERMIT ISSUED---------- __. DATE �� l A __ y i. -- ------------------ Alterations and/or-recommdnda�+ions _ - --- -------------------- --_----•-----------------`---- 'Pi ------t••-- ^+ f AEr _- _. --------------------------- -----------------------.---------r --- ------------ -------_ -- ----------------------- ------- ----em--- ---- ------------------------------ --------------------- ----------FINAL INSPECTION-BY:- Date. SAN JOAQUIN LOCAL. HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100 fl