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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) J Date Issued Aat�. J0DAW D Ste` �e Application 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. 544. $ o 4� = -.fit- - � ��-- -��-� ------------- JOB ADDRESS AND LOCATION__-�_.__�_.__�3 ex_____� � � � q Owner's Name------------------ �+ ..--- k=*.F��- �-�-------`------------------------------------------ ------------ , -�"�_?_A�---------- Q � � Phone Address-------_o'bi't'. .............I.A Contractor's Name------------ . 41.. -Z-��4I n--C{----------------------------- Phone---�9nf,6_�-7•------- Installation will serve: Residence A, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_.-- Number of bedrooms - Number of baths _1____ Lot size __//__--..�, —----------------------- Water Supply: Public system E] Community system 0 PrivateX Depth to Water Table !-e_ ft. m -I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑! Previous Application Made: Yes ❑ No X, New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest wells 0�___Distance from foun ation__ _ h Matenal .+ r+ No. of compartments______ —------------Size._7�� 'Y4 3Llquid depth---e --`_'_------CapacityxE0_O.� Disposal Field: Distance from nearest well-A&/_�.Distance from foundation-______Distance to nearest lot�lin/e________/_ -rte Number of lines_____________�__�__---________Length of each line_�Q --------------Width of trench----��__Z""-------------- Type _________._-_ T e of filter material--�__ Depth of filter material_____�_�_`--._Total length---!__G_�a__'_______________--____ Yp �---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______________\)�k❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------.-_----_------------ Cesspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material____________________ --� ❑ Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gaIs. Privy: Distance from nearest well-----------_-------------------------------------Distance from nearest building_______-_________--______-._-________ ❑ Distance to nearest lot line--------------------------------------------------------------------------------------- ---------------------------------•-------------------- Remodeling and/or repairing (describe)_______ _ _ ------- ---- ___________ ______ __ -___ ------------------------------- --------------- f------► cel --------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------------------------------------------- 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, aand' regul tions of th Joaquin Local Health District. (Signed} �....�I^.C---------------- ;------- --- -- Owner a d/or Contractor) By: t l - ,.� --------------------------------- --------------------------------------ITitlel- (Plat plan, shovig size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------------- DATE --------------------------------------------- APPLICATION ACCEPTED BY __ - �• REVIEWED BY -------- DATE------ BUILDINGPERMIT ISSUED--------------------- ------ --------------------------------------- DATE-----------�------------------------------------------ Alterationsand/or recommendations----------- ------------------------------------ ------------------------------------------------------•---------r-----------•------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------•----------•------------ --- ------ a - ------------------------------------------------------------------------l--- .. ------ -- -- ----- FINAL INSPECTION BY----------- _ ------ -_ - ---------------------------------- Date-.------- -- ---=_4----------•-----------------•--- 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 ES-4-2M B-51 Revised W-2100