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APPLICATION FOR SANITATION PERMIT Permit No. L (Complete in Duplicate) Q , Date Issued 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. JOB ADDRESS AND LOCATION---- ''-— -�------��'Y1_�4�J ,p I Owner's Name-------- l '_--.-G__j"_'�TC.�? h_ Phone ` 'y �r �. Address &----------------------------------------------------------------------------------------•-------------------------- ---------------------------- ContractorsName,------------- � g----------------•------------=----------------------------- -------------------------------------------- Phone----------------------------------- Installation will serve: ResidenceW Apartment House Commercial 0 p ❑ ❑ Trailer Court ❑ Motel ❑ ,Other Number of livingunits: ___I__- Number of bedrooms .- I b4 .�._ Number of baths ________ Lot size _-___-______________�© ----------------------------------- Water Supply: Public system ❑ Community system ❑ Private `.Depth to Water Table .------- .f+. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay~b Adobe❑ Hardpa❑ Previous Application Made: Yes ❑ Nol;� New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool permitted-if p Sewer is available within 2 =feef:),, ` Iff - a *$74,'ot Distance from nearest well_ a e iaL :---------.�'-.---------- : p - ro• - R 99,, No. of com artments :, Size-- --------------------------Liquid de ----- -----------------Capacity------- ---�-----------''V Disposal Field: Distance from nearest well__.4�'---Distance from foundation__I�_______rD,istance to nearest lot line------- RK Number of lines---- ----- -- -----------------Length of each line�'j!�js"14 .._---.Width of trench ___.,. c-��--- ------ - w Type offilter material-____..___Depth of filter material___i.�------------ length------- -i,--____ -------------- Seepage Pit: Distance'to nearest well___-------------------Distance from foundation-------------------Distance to nearest lot line__,___---________ ❑ Numberof pits----------------------Lining material---------- -----------Size: Diameter----------------- - ----Depth--------- ---------------------•M` s Cesspool: Distance from nearest welL________________Distance from foundation--------------------Lining material___.____-. :__._______._______-- ❑ Size: Diameter----------------- ----------------Depth --- ------------------------- -- -----------------Liquid Capacity-. ------------r----•------gals:.n Priv'y: Distance from nearest wO-------------------------------------------------Distance.from nearest building---------------.--------- -_- -- , - _, - ❑ Distance to nearest lot line--. Remodeling and/or-repairing (describe):--------------------------------------------------------------------------------------- ------- •- -;� ----------------•-------------------- -------- --------------- ------•---•---------------------------•-----••---------- ---•---------------------- -----------------------------:•------------•-----------------------------------...--------------------------------------- ------------------------- ----------------------- I ---------------------I hereby certify hat 1 Jt,7e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St fe s, ules and regulations of the San Joaquin Local Health District, �Y (Signed); s� 45- ------------------------------------------------------------------------------------- - -----{Owner and/or Contractor) �y:--------•---------------------------------- ` = (Title) ------------------ --------------------- ---- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -- --- - ------ .ra�t.� DATE -- ------- -- ---------------------------- REVIEWED BY ------ - ----- •---------------------- DATE ----------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:---°------------- ------------------ ------- ---------------------------------- ----------------------• ---••--------.----- - ------------------------------------------------------------------- ------------------------------••------------------•----•---••--------••------------------------ ----------•------------- --------------------------------------••-------------------------------------•-•-------------------------------------------------------------------- ------------------------------------------------------ ---------------------------------•------------------- - ----------------------------- ---------- ------------------------- ,�` F1NAL INSPECTION 6Y:. -------�--------•----------- ---------==e°'��."----- . Date- - - ------------'- ----" =�------------------- SAN JOAQUIN LOCAL HEALTH_ DISTRICT 130 South American Street 300 West Oak Street s 132 Sycamore Street 814 North "C" Street- Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100