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q APPLICATION FOR SANITATION PERMIT Permit No. �' (Complete in Duplicate) �� Date issued _ ✓ _-''---------- i _ _-- 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. 549. i �t `fri ` S !��}s;aV� 06 OB ADDRESS AND LOCATION... t- '------ ° -------------------3,44/x''"------.MEL Owner's Name--------------- rs �7. Phone---'---------------------•-------- ----------- �- ---------------------------------- -- - ----------- Address--------------------------------------------------------------- -------------------------------------------r------------------------------------------ Contractor's Name-------------------------------------- -------------------•------- ------ Phone----------------------------------- Installation will serve: Residence A) Apartment House ElCommercial C] Trailer Court'E] Motel [-] Other E]' Number of living units: -------- Number of bedrooms __,�--- Number of baths ._. _ Lot size -----e0-��i`_____ 6__0------------------------- Water Supply: Public system ❑ Community system ❑ Private IVI Depth to Water Table -------- ft,, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 10 Hardpan ❑. Previous Application Made: Yes ❑ NonP"I 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 weii-----------------Distance from foundation-------------------.Material -___._-----_-.--__----.._-_--_---...__--_ No. of compartments--------------------- Liquid depth__.------------------- --Ca Capacity J �. ---Size---------------- p y---------- - Disposal Field: Distance from nearest well__.__5 --__.-Distance from foundation_---_ �--_ Distance to nearest lot line-- _a Number of lines------------------------i,--------Length of each line.------- ----- -f;-----.Width of french------------ - -----------= Type of filter material-_-_---1./........__Depth of filter material--------� .____--_Total length_______________ "ter----_-_-_-"_---_ ? Seepage Pit: Distance to nearest well----------------------- from foundation_ ________________Distance to nearest lot line--------------- ------L' in material------ ----------------Size: Diameter----------------- -- Depth❑ Number of pits_____________ g. p O Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------ 1 ❑ Size: Diameter--------------------------------- ----Depth----------------------------------------------------Liquid Capacity---------------------- g i ................Distance from nearest building . Privy: Distance from rom nearest well---------------------------------- g--------------- ----_______--__. ------- ❑ Distance to nearest lot line--------------------- ------------------------------------ ----------------------------------------------------------- --------------------- Remodeling and/or repairing (describe):-_------._----------------___----_---___ -------------------------------------------------------==---------------------------------------------- d --------�--------~ _ • __ ----- --------• ------------ _______________"a,Y _.____________.. __,____.________..________.__________._______._ ________----_----_---------_--__-___-_.__-.-___"-__----..-_ .._. .__ I hereby certify that I have prepared this application- and that the work will be done in accordance with San Joaquin Coun ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Signed}-----� -----'---- ------- ----- - ____________________(Owner and/or Contractor) Ian, s -- - " - - --------------------------------Title (Plat p showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USEONLY APPLICATION ACCEPTED BY------------I-------------- -- --------------------- f��3 DATE REVIEWED BY------------------------------------- ------ - --------------------------------------•---------------------------------------- DATE-----------------------------------•-------------_.._------ - BUILDINGPERMIT ISSUED----------------------------- ----------------------------------------------------------------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:---:'------------ --------- ------- ------------------••---------"------------------------------------------------------------------------------ ---------------------------------------------------- --------- ----------------------------------------------------------------•---------------- ------------------" -------•--------------------------------------------------------------•---------------------------------------------- -------------------------------------------------------------------------------- -------------- Date---------- --------- - ---- ------------------------------ FINAL INSPECTION BYE ---------------------------- + 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-9-2M �0-52 Revised W-2100