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APPLICATION FORS SANITATION PERMIT q h �Permit Na _-0.--�-- (Complete in Duplicate) �� •� Date Issued Applica¢ion is hereby made to the San Joaquin'Local Health District for a permit to con truct and install the work herein described. This application is made in corimpliance with County Ordinance No. 549. } �A � --------------------- ----------JOB ADDRESS AND LOCATION....� ----- ------------- -- -------- -- ----- ---- Owne`r's Name ------------ -- ---- Phone_ .. .-..- r.r.'- c1 -.. • ..r. H- --- ---------------_________________________________________________ Contractors Name ; ------- --i; -._. Phone Installation will serve:=Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel,❑ Other ❑ Number of living units: --07- Numl�e)rof bedrooms __ }Number of baths __� Lot size,//-S---__�___,!-.��0__________ ________ Wafer Supply: Public system [Community system 0 'I'riyate'L Depth to Water,Table -�Sft. Character of soil to a depth of 3 feet: Sand ❑ GravelA❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El Previous Application Made: Yes ❑ No 5R1New Construction: Yes �No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic.fank or cesspool permitted if public sewer is available witli12b0 feef.)7.y Septic Tank: Distance from neare f well Distance from foundation--- Material---------------_____ ______________: No. of compartments' } .'Size =-I ---_Liquid depth- ------------- --------Capacity--.-- ----------------- - Disposal field: Distance from nearest well___ Distance from foundation __ .- _.-_ .Distance to nearest lot line_________________� ❑ Number of lines---- -- - -------------------- -Length of each`(ine------------- --- ---......Width of.trench----------------------------------- Type of filter material '" "" "'--;K-.---.Depth of filter rriateriaL ._.___ ; __Total length__ ,� e'.A�e: Distance to nearest well Q Distance from�foundetion____��______-.Dista r e to nearest lot line__________._ Number of pits _.1__ _.Lining material_ _�' Size: Diameter--3-3-8'-" - -__-__Depth_ _ ----;F-,5 ______________ Cesspool: Distance from nearest well_° .__ c Distance from foundation__„__ ____-Lininmaterial____________________________________ I ='�_ 'De th---�4- }-�� Y� ----------- Liquid Capacity-... gals, p q p Y -9 Privy:❑ Distance from nearest Well___:___7e I 7 # Size: Diamtiter----------------------------- S t � �y. t �:-....__._. ._ -�._�Distance from nearest building _ ❑ - Distance'to-nearest,lotlline_ .-'------1- ._ ,..-- -- •”. . i r-- — w i _. ( ----- ' Remodeling and/or repairing (describe�:� � d --------------------------------------------------_______ _____________________________"-__-__________ ________-___--_-______-_.____.-_:______.___________________.____--._-----------------------..-___ _____ __ _-_._.____----._-___-_____-_____-______________ _ ______-______- _ _... 'l ----------________________________________________ _______________________ ___________________________ _.__--. - . --....______ ` ____________________________________________________________________ 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'liacal Health District. (Signed 4� - --� - ------------------=-----" -- ner and or Contractor Title (Plot plan, showing size of lot, locationf system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-4--: ------ o ...... . ---=---------- ------------------------ DATI � =� �� REVIEWEDBY---------------------------------------------- - ------:------------------------------------------------- --------.----- - -.- DATE-------------------------------.__...._. --•--•`. -"---- BUILDING PERMIT ISSUED- ----------------------- ------ •---------- = DATE.:---------------------------- ----------------------- _: - •• --------------------- ------- Alterations and/or recommendations:------------------------------- " =------•-•--•--------------------------------- ---------- _ - k r -------------------------"--------------------------------------------:------------- -----------------------------•------------------------•----- -------•--------------------------•---- -------------------------- ------------------------------------------ -_-----------------------------------___________...______.__________--___"-_.-._—--.--_______..______._.____.__-__- _ - - FINAL INSPECTION BY- �!�"-:- ?- --- -- - - Date ---�' -'-�J/� 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 } FES-9-2M ; Revised W-2100