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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3 S 1p' Date issued Applica+ion 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-_ - ------ U C. ..l ---- --------------------------- Owner's Name---------------------1- len -------L----------L----A. - ------ ----------------------------------------- Phone- Address-----------_------------ hone Address-----------•------------- YY1 _. ....... Contractor's Name------------- -- ------------------------------•----------------------------------------------- Phone_-�1�---�Y-��--q-/----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I--- Number of bedrooms __/--- Number of baths .,/---- Lot size _ —---------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 14Aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9-- Hardpan ❑ Previous Application Made: Yes ❑ No FA�New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) is Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------- ---------------_--------------_. 6&:_� No. of compartments--------•----------------Size------------------- ------------Liquid depth--------------------------Capacity....------------------- DiaginsalFeldDistance from nearest well-----------------Distance from foundation----___--- ---..-.Distance to nearest lot line-------_ rc�T ` � Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material--------+--_---------------Depth of filter material---------------------.-Total length------------------------------------------ o Seepagevit: Distance to nearest well110-ti-e------Distance from foundation--- __.._..Distance to nearest lot line---_--vr_'.. N Ell Number of its__ Lining mate ria l_CU.,_ -----Size: Diameter-_J3_�t.___.Depth----P,2-_-X--------_____----_ Cesspool: Distance from nearest well-----------------Distance from foundation-- .-_._--.Lining material------------------------------------- El Size: Diameter---------------------------------- ---Depth_--------------------------------------------------Liquid Capacity----------------------------gals. p Privy: Distance from nearest well ---________------------------------------------Distance from nearest building.-------_-._-.._--___._-_-__._--.--.-----. ❑ Distance to nearest lot line----------------------------------------------------------- ----------- ------ -----------___ ----------------------- Remodeling and/or repairing (describe):--------------------------------------------------------•-------•-------------------------------------------------------------------------------•-------- -------•----•-•-------------------------•-•------------•--••-----------••-•----•-•------------•----------------------------------------•-•--•------•--------------•--•--------------------••-•-------------------------------- I h certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat`lws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---- ----------•--------------- -- ----- -r-- -- --------------------------•--------------••-----------(9.��Contractor) By:--------------------------------------••---•-•-•-=••- ••---------------- ----------------- (Title) 11YYr_C7 � ----...---------- (Plot plan, showing size of lot, location of system in re! ion to wells, bua logs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- ----------------- ---------------------------------------- DATE-------!�---------------------------------------------- - REVIEWEDBY------------------------------- ---------- -- - -------- -------------•----------- ---------------------------- DATE----------------1�1----------------------------------------- BUILDINGPERMIT ISSUED----------------------------------- ---- - -------------•------------------•------------ ------ DATE-------------------------%-----------•--------------------- Alterationsand/or recommendations---------------------------- ---- ----- -------------------•-•------•--------•-------------------------------------•----------q---....----------._.. •------•--------------------------------------------------------------------------------------------------- --------------.------------------------------------------------------------------------------------------------- -------•------------------------------------------------------------------------------------- ----------------------------------------------------------------------•---•-------------------------------•------------•-- r ------------------------------------- --------------- ----------------------------------------------------------------•-:------------------------------------------------------------- FINAL INSPECTION BY:--_ 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 Reviied W-2100