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•fit yqq ' F' - 4')' APPLICATION FOR SANITATION PERMIT Permit No, `•-- 1 (Complete in Duplicate) l o /V/ � Date Issued ------ --- TT Application is he b Lade 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 __ �j rs �-`!'! a"^- l ev-.4 ---- Owner's Name------------"----0-f----C----- ----------------- Phone----------------- - ----------------------- ---- //Q -------- - Address. ------------------ Phone---------------------------------- Contractor's Name------------------------------------------- - - ---- -- --------------------------------------------------------- Installation will serve: Residence 5ff Apartment House ❑ Commercial ❑ Trailer Court ❑/Motel [IOther ❑ Number of living units: - ___ Number of bedrooms -/---- Number of baths _/______ Lot size Q___ fD--+��------ Water Supply: Public system Xj Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No 5�-' New Construction: Yes P-*INo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e . Distance from foundation--_fd--------.Mater I___-A- Lpo.cl ----•Septic Tanl;: Distance from nearest well � _ p- Na. of compartments. - Size--rX_h-,X3----Liquid depth-----5---y----------Capacity 4---------------- 2O_-____.Distance to nearest lot linea _________ Disposal Field: Distance from nearest well____"--------Distance from foundation----_____ Q T umber of lines------------ /'4-LL --_-- --Length of each line--------0!- ---_- of trench------ - - ------------------ Number ------------ ---- ype of filter material.__ _f -Depth of filter material-__--f-r-~-----Total length--------- -----------------------•- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____--_.________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------------- --------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material______________________________._____.{� ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance rom nearest building----------------------------------------- ❑ Distance to nearest lot line------------------------------ ---------------------------------------------------------------------------------- ------ C. Remodeling and/or repairing (describe)---------- ----- -------------------------------•--- ------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ------------------------ -------------------------------- -------------------------------------------------------------------------------------- ------------ ----------- -------------------------------- -------------- ----------- ------------------------------------------ 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 . les an regulations of the San Joaquin Local Health District. (Signed)-------•---- ». --- -- ---- -------------- (Owner and/or Contractor) 4 By:----- --- --- -- �--- ---- ------ --------------------------------------------------------- -----(Title)--- = (Plot plan, showing size of I f, location system in relation to wells, buildings, etc., ca 'be placed on reverse side}. m - FORD RT NTS ONLY APPLICATION ACCEPTED BY---- ..--- ---e-- - r -- - -� .--•--- ------- DATE -- � ------ 1 REVIEWED BY-------------------------------- ------------------------ DATE----------------------•------• - -- --- BUILDINGPERMIT ISSUED-------------------------------------------------------------- --------------------------------------- DATE---- -----•------------------------------------------------ Alterations and/or re rofmmendations-------------- -------------------------- -------------- - --------------------------- r _ ---- ----------------------------------•--•-----------------------------------------------------------------•-----------------�--------------•--------'--- -------------------•---- ` --------------------- -------------I------" al FINAL INSPECTION BY------------- -------------------------- Date-------------- ------ --I-- ---- --- )------------ -- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 3 Stockton, California Lodi, California Manteca, California Tracy, California f ES-9--2M B-51 Revised W-2100 y