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1 APPLICATION FOR SANITATION PERMIT Permit No. ___-- ..�-7 ••-- �1 - (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. r JOB ADDRESS AND LOCATION------- -'c J ` i q --T --------fit ' --- �.� E1_l ----------------------------------- ----------------------------------------- Phone-- ... hone- Ownar s Name----------- ----- Address_________________ __ , Contractor's Name i_,4------ 1� ----" p _-- {-&----------------- Phone G Q Installation will serve: Residence [Z Apartment House ❑ Commercial ❑ Trailer Cour# ❑ Motel ❑ Other ❑ D X s Number of living units: ___~____ Number of bedrooms _,,Z._ Number of baths .------- 'Lot'size ________ _ ___�_ -.-___/.e a._____.____________._ Water Supply: Public system Community system ❑ Private:❑ Depth to Water Table, _ ft. Character of soil to a depth of 3 feet: Sand E] Gravel 1-71 Sandy Loam El Clay Loam El Clay ❑ Adobe R] Hardpan ❑ Previous Application Made: Yes ❑ No lL New Construction: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) 14 Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material -__.______.___.___---_______.-.________-_______. ❑ No. of compartments --------Size-----•----- ------------•-- ----Liquid eph--------------------------Capacity----------------------- d Distance to nearest lot line --: -_. Disposal Field: Distance from nearest well___/.-++✓_.:Distance from foundation____{R __-- - r�'� Number of lines-----;-/- -----Length of each line------- - --------.W�dth of trench------, ----- --- --- + Type o€ filter matenal._-_ QG _____Depth offfilter material---J2_ _ _____._Total length_____ -_„rte...... r / �-� 3, ..__._..Distance to nearest lot line--_J_________ Seepage Pit: Distance to nearest'well__1��1�E----Distan e from foundation____._ ® g - .....Depth------—IS--- ------------ Nu \ Number o{ pits--a�_______________—Linin xmatenal-_�Q�____�_-Size: Diameter_____ p Depth- from foundation --------------------Lining material_------------------------------------ ❑ _ Distance _14 ------------ ------- - ------ ----Liquid Capacity----------------------------gals. IN Size: Diameter- ------------------------------------------------------ iameter ' Cess ool: Distance from nearest we __._ .____ Distance rom nearet well>: -------------------------------------------- Privy.: Dista rice from nearest building______________________--_____.---_____. s , ❑ Distance to'nearest lot line - = - ------------------ • ___________i__-_--_.-______....___-.._____.. ---__....____________._.-__________.______....__________________-_____________ Remodeling and/or repairing ---(decrf %yam ;..f � `} w..cz ------ -------------- t ------- -•--------------•-----------------------•------------------•----------------- ------ •-- -•----- r f _________ ______________________ ._ ________ _____ _ _ ___________ _____________ ______________________________________________________________________________________________________________________.._..____._____ 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 d rules and re ons of the San Joaquin Local Health District. ,¢• '" -•-------------------(Owner and/or Contractor) (Signed) _ =..... - -- -------------------------------•---------------------------------(Tit ) (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc.,'can be placed on reverse side): \ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- �------ - --------------- ------------------------- DATE------------- DATE - ------------------- BUILDING PERMIT ISSUED------------�n .�- DATE -- -- r 's - Alterations and/or recommen atios:__ __- _ - 7-------------------- z s � ---------------- Date----- FINAL INSPECTIONBY:__ - ---- ----- --- --------- _ 7-- ----L SAN JOAQUIN LOCAL HEALTH DISTRICT. 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised W-2100