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r�. ' e1 APPLICATION FOR SANITATION PERMIT Permit NVereindescribed. -- ...,� in Duplicate) Date Issutsr.3 I (Complete Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND LOCATION---- Owner's ................... Owner's Name---------------------------------- ------C.&---/ = ./ ------- -------- ------------- Phone-- ----- Address. ........ ------•----------••--••-•------------- Contractor's Name----------------------------------u-avLA'4- ,. ------ ----------------------------------------- Installation ------•--------------------------------Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I s Number of living units: _/-... Number of bedrooms _. Number of baths /..._ Lot size _. 'C?.`�__T�...�. --------------------- Water Supply: Public systef-,K Community system ❑ Private ❑ Depth to Water Table �. G- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Qt,Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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 well------- ---------Distance from.foundation------------------- Material------------- .-.----.._-------------._.-._... V &LZj-4-7 No. of compartments----------- ------------Size--------------------------------Liquid depth---------- - ------------Capacity----------------------• osal Field: Distance from nearest well_________________Distance from foundation.____.._.___..._.Distance to nearest lot line._._-........_.. ��` Number of lines-----------------------------------Length of each line"---------------------Width of trench------ -------------------------•-- Type of filter material--------------------------Depth of filter materia----------------------- length----------"+._-_-...____--------_._.-.._- See a a Pit: Number of pts-este---.��_ng material e�un ations-�Q.r._.. D"st ncq to nearest lot line-_...��----_ to r I �!, 00 size: Diamefer...a-- --------- -- Depth--,�- ----------------------- A - ---- ------- # pA Cesspool: Distance from nearest well-----------------Distance from foundation____________ ______Lining materia(--------_-.-----------------..__-.... ❑ Size: Diameter----------------- `- --- ------.Depth-------------------- ------------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well---------- ------------------°----4'..Distance .from nearest.building------------------------------ ----------- El _...-.__._.----..._--.-.--____---.---- ❑ Distance to nearest lot linn/e!----------------------------------------------------------------------------- -------------------- Remodel 1 k, 470 Remodeiin and/or repair'ng {des ribs]:-----.1!: - _ i'.. �t- r-Q.c -1 -t�oxk_ �y -� �![�f�I�r- I7sK — y --------- i �4 =e .-t< +. 4 -o �, - ---•- ^- ti . _4.- ..lz ----•-------------- I hereby certify fhat l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ws, and rules and=fl the San Joaquin Local Health District. � I (Signed)----------- --------•---------------- - 2in ------ -- - ---------------------------- r Contractor) ------ By:----------------------------------------------------------------------------- -•-- ----- ----------------(Title)- ......... (Plot(Plot plan, showing size of lot, location of system in relo wells, buildi s, etc., can be plated on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------- --- --------------------------------------------------------- DATE.- --------------_-_---- l - - REVIEWEDBY -------------- •-- --------------- ----- --- ------ --------------- - - ---- DATE..-1-----------------------------•------------------- BUILDING PERMIT ISSUED-----------A------------------------------------------•--------------------------------------. DATE.------ ..----------- Alterations and/or recommendaf ions:------------------------------- -- ----------------------------------------------------------:. -------•---------•----•--•------------------------------------------------•--•----------------------------------•-•-----•------------------•------------------------•------------------------------------------------------ -------•------------------------------------------------ ------ ------------------------------------------------------------------------------------------ ---------- -------------------------------------------------•--- ------------------------------------------- --------------------------------------------------------------------••------------- --------- ----------------------------- ---------------------------------------------------- FINAL INSPECTION BY:- ?�C F �� --'� !l7- -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