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APPLICATION FOR SANITATION PERMIT Permit No. ___-_V_!___.._..__-. (Complete in Duplicate) Date Issued _______________ T pplica{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--------=--F-•-�� Y_9�..--- �1_21/ -------1306/ °----------------------------'--------------------------------------- r Owners Name---- ,... a ----- -----•---------- Phone-------T-- --•----•---•-----------•--- Address._ . - ../j r... -- l B : ---------- . ` ------------------••-----•----•------------------------------------------------------------------- Contractor's Name---�- /[ - ------ � ��d +E .•------------------------------------------- Phone_-4. ...C _d_7 Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ { Number of living units: ..! Number of bedrooms _:7_--Number of baths ----/-,- Lot size ----%`--_._2?�__L7!0�__________________________ Water Supply:- 'Public system "[ Community system ❑- Private ❑ Depth to-Water Table,6 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑. Adobe E5, Hardpan ❑ Previous Application Mader Yes [❑ No New Construction: Yes E No ( c TYPE OF INSTALLATION AND SPECIFICATIONS: {.(No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic-Tank- -•——Distance from nearest well-----------------_Distance from foundation-_:-----------------Material------------------------------------------------- t} ❑ compartments-__ -- p ---------------'Size---------------•-------•--------Liquid depth ----- -- - ----- CapacitY--...,------------- ' LU Disposal Field: -Distance from nearest well---------------._Distance from foundation--------------_-----Distance to nearest lot line.___-_-__________ ❑ ber of:lines-------------------------------------Length of each line------------------------------Width of trench----------------------------------- z pe of filter material-------------------------Depth of filter material-----------------------Total length----------------------------- ------------ e Seepage Pit: Distance to nearest well----/Ax-P_.Distance from foundation_raQ_-__=.-..Distanr'ce to nearest lot line___./.------- QNumber of pits-------_____,______Lining material-- _ '=� -S4 : Diameter__:f._- _-------Depth__.. : ---------------- Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material___________________.-__-___-__-___-_. Priv. 1 Distancefromnearest well -Depth -------------._..:Dis------- -----------------Liquid CapacitY-------------------------_---gals. i tante from nearest building g--=-------------------------------------- ., Distance to•nearest lot line--------------- - - - .. =- ------------------------------- Or --------------- ---------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------------- i a - }-r-- t ! F -- - - -------------------------------------------------------------- ------.....-•----•---------------------------------------•----....- --------•---------------- !r hereby certify that I have prepared this application and +hat 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.. (Signed)......... ------ ----- - z----------------------------------- ----------------------------------------------- -- Owner and/or Contractor -----------------•--- ----- ----•-(Title)------ ------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ---------- " A / 1 f------------------------------------=---------- REVlEW1 D BY = -------:-- = =---------- - ------ DA E ----------------- BUILDINGPERMIT ISSUED------------------------ `--=-------------=------- DATE----- - '� ------------------------------ ------------------------------ --------------------•- Alterations and/or_recommendations: r ------------- ------ ------ ------------------------------------------------------------------------------------------------- ---------------------------------------------------------- -- ______________________________ ______ ________________________________________________ -__-__-___.________-_____----_�_...---.___.__.._._____ _.____-__________.____-___________..______________________..______- r F FINAL INSPECTION-$Y:. - Date `y `�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street- 300 West Oak Street 132 Sycamore Street $14 North "C" Street r Stockton, California Lodi, California Manteca, California Tracy, California n . ES-9-2M Revised W-2100