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e� APPLICATION FOR SANITATION PERMIT Permit No. _�__ '-Y_, (Complete in Duplicate) (Q Date Issued - ------------/5 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. '1 JOB ADDRESS AND LOCA N +2 -f!/�! d-' cG __ � � rk / ✓ r• Owners Name 1 l L.rL /0 •--------- --- ---------------------------------------------------------------- Phone---------------------------------- Address --- ---------� -------------------------------------------------------------------------------------- GContractor's Name----------------------------------------------------------------------------- -------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence JK Apartment.House E],---Commercial [-] Trailer Court [-] Motel ❑ Other ❑ s ` Number Pulicunits: / Number f bedrooms"living ___ Number of baths _/-___ Lot size __-��----%�`--CJS..� ------------------------ Water Sustem Community 1 pp y= y # y system ❑ Private ❑ Depth to Water Table -------- ft. 1, Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nof4 New Construction: Yes RNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) 4 Septic Tank: Distancezom nearest well_-Mw__-Distance from foundation___,/-.--.----.Material---- -. 4 _----_---- // 4:7 = ❑ No.,o(compartments---------i�-----------Size--- �C2.1 -----Liquid depth---5�Z-- ------------Capacity--- Q d------ Vv Disposal Field: }'Distance from nearest well___------ Distance from foundation----�-�_-----Distance to nearest lot line------ ,Number of lines_------ - f� ------ Length of each line------ f1----------------Width of trench------ - --- ---___--- Type of filter material- 1 ' _ {;• Depth of filter material-----If --------Total length---------�jO----------------------- - ; Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_-_---__--_--_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: --------_-_____------_- -------Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------- --------------- E1 _____------_--_--- _--❑ Size: Diameter--------------------------- - --------Depth----------------------------------------------------Liquid Capacity-------------------- gals. Cr Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ,--_--_-____------_____----_-----------_ ❑ Distance to nearest lot line Remodeling and/or repairing (describe):--------------------------------------- ------------------------- --------------------------- ----------------------- ------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 rule and re lations of the San Joaquin Local Health District. (Signed) ----------- ----------------------------------------------------------------------(Owner and/or Contracto�i BY: -- --------------------------------------------------------------(Tif le)------------------------------------------------------------- ? (Plot plan, sho ' size of lot, ocation of s . em i relation to wells, buildings, etc., can be placed on reverse side). FOR IP RTS ENT YSE ONLY APPLICATION ACCEPTED BY------ -t--- X,1-7 - - ► - ---- ------------ --------------------------------------------- DATE- � REVIEWEDBY--------------------------------- --------------------------------- ------------------------------------------ DATE ---------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------ DATE--------------------- Alterations and/or recommendafions:-------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------•---•---------------------------------------------------------------------------------------------------------------------- i ------------------------------------------------------------- ------------------------------------ ------------------------------------------------------ ------ ` { FINAL WSPECTION BY:- ----------------------------- Dat-- -----=- ---- ----------------------------------------------- --------- JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street t ., Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M-8-51 Revised W-2100 ..