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•s y APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued �A_6__s'3 r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-2--Q--r �2 ---�'/- '� - <<vf�r� SJR ---,� _- r4' l« �-.--4 _ , Owner's Name-------- -------------------------------------------- L�-�l%=�'•-•--�--�-��-------•--•-------•-------------•--- -- --- Phone----,-�-�' _ Address ----------------------- 47-1 Contractor's Name------ s_f�. ��. -� f r < �?i' = ------------------------ ------------ Phone../=-,_/-- =-.0.. �---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. -- --- Number of bedrooms ---j-3- Number of baths ---L_ Lot size ------------------- Water Supply: Public system ❑ Community system ❑ Private F1--15_epth to Water Table 1! ft. Character of soil to a,dep+h of 3 fee+: Sand ❑ Gravel E] Sandy Loam E] Clay Loam f Clay El Adobe El Hardpan ❑,- Previous Application Made: Yes L] No �ew Construction: Yes 2_1�10 ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: s` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Tank: Distance from near'es't well-----------------Distance from foundation--------------------Material----------------------------------------.------- ❑ No. of compartme;ts--------------------------Size------•------------- -----------Liquid depth--------- t Capacity---------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation---_--_-__f-____.Distance to nearest lot line--------------- .or Number of lines---�-�-----------------------------Length of each line----------------------'------Width.of trench--------------------------------- Type � Type of filter mate-•ial-------------------------Depth of filter material-------------- ------Total�Iength----------------------------------------- See ---------------------------------------- 'tt Seepage P t: Distance to nearest:well--e_--------------Distance from foundation--------------------Distance to nearest lot line--j� :..------.. Number of pits..-.--i/---.-------Lining materlalrD_(Ss'-Z�% c/YSize: Diameter_-- Depth-----. _Z_0--_----- ------ Cesspool: Distance from nearest well-----------------Distance from foundation------------I----- Lining material--.---.--------------------.___----� ❑ Size: Diam9fer------ �---------- ---------- -------Depth---------------- -----------------------------------Liquid Capacity-.--------------------------gal (' Privy: Distance from nearest well------------------------------------------- -Distance frominearest building--------------------------------------- � ❑ Distance to nearest lot"line_„-�_•-___.,. .- �--------------------------------------------------`--------------------------•---------------------- f� Remodelingand or'repairing (describe,):,- __-f �f-E__/'_ f--_ r 1 Ir �'" 1 �, ------------------- ---- -----------------------------------------------------------------------------------------------------------------------------------------------------------•- ---- ------ -- 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 Local lHHealth District. (Signed)• _ k (Owner and/or Contractor) = j if 14;t 2 (Plot plan, showing size of lot, location of sys(em in relation-+o wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY-------- --- �_ �.: fX��t. -------- DATE---- -- --------------- REVIEWED BY -4 ----- --------------------------------------------------------- DATE----- ---------------------I BUILDINGPERMIT ISSUED---------------------------------------------- `----------------------------------------------------- DATE-- ---------------------------------------------------------- Alterations and/or recommendations------------ ----------------- F-------I------------------------------------------------ --------------------------------I—---- ----------------------- ----------------------------------------------------•------------------- -------------------- - ?- - -----------------------------------------------------------------------------•-•---------------------------------------- 'r ----------I---------------------------------------------------•----------------------------------------------------------------------------------------------------------------------••----------------------------- r1 FINAL INSPECTION BY-------------------1--- ---1-- - - -------- Date --- ------- --= --- ------------------------- 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 10-52 Revised W-2100