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f ►� �`�', APPLICATION-"-OR='SANITATION PERMIT Permit No. ...5!! --- ---- (Complete?iri Duplicate) Date Issued Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install he work herein described. This application is made m—comp fiance with County Ordinance No. 549. SL// . � 7 lg , 'cam � t �DRESS ND LOCATION...._ E-n -cJOB AD � ------ Owner's Name------- --------- --------------- � -- ------_ Phone--------------------•--- ,n h ------�--_-_�- -- -Address_....----.cz ----••-- p / ----------------- ---------•------------- Phone_ —Zi Contractor's Name I Installation will serve: Residence [ Apartment Hoiuse ❑ Commercial ❑ Trailer Court ❑ yMotel C1 Other E]Number of living units 7�7 Number of bedroom' __il Number of baths _`� Lot size ______ __ _____ _1_ _____________-_.- Water Supply: Public system W Community system ❑ ��Private ❑ Deptii to Water Table�� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PQ Hardpan ❑ :y Previous Application Mader Yes ❑ No I& New Construction: Yes ❑ No A } TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanl sane from nearest well___ _____ Distance from foundation------------- _____.Material____-____-----____________-________--------____. ❑ !1` No. pf compartments-•-------- ---------------S"r ------•• ----------------Liquid depth-------------- -----------Capacity ` Disposal Field: Distance from nearest weft------------------Distance from foundation--------------------Distance to nearest lot line----------------- --.-.Width __________--____ rnes __ Length of each line------------ - ._Width of trench o� ❑ �� e"/or filter material----- ----------------Depth of filter materia4------------_---------.Total length----------------------------------------- (� Yp � r v. ,,rr Seepage Pit: Distance to nearest well_____fv_a�'�'Distance from fquoda ion----�_____._•_.Distance to nearest L �c.�c �l: �--�- ------Depth----- Nu' mber of pits______________________Lining material__________-_ _____-_Sz Diameter__ Cesspool: Distance from nearest well-----------------Dstance from foundation------------------- Linin material__-____--____,'________--.------------ .. ❑ Size: Diameter--------------------- -- -----------Depth----------------------------------------------------Liquid Capacity----------------------------gals, nearest building---_------------------------------------ Privy- Distance from nearest well.---__________-----{� ----------- ----------------------- - -------------------------- Distance to nearest fat'line Distance rom ------- " ---=----- ❑ ---------- � Remodeling and/or repairing (descri6e):------------------------------!-- ---------------------•------------ ----------- -•-------------•-----------------------•------------ a 5 'f`'` " �� _ e a --0- ^--------� --------------------- ----------------------------- •--------------------------------------------------------------------------------------•-•-------------- Y T ` I hereby certify that I have-prepared this-application'and that the work will be done in accordance with San Joaquin Count ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. Si ned -------------------------------------------- ----------- ------•---------------- (Ow er and/or Contractor) 1 ----- -- t—-- in relatio_ -_ -�_�cal ITitle) - --- f (Plot plan showing size of lot, location of y n to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY i APPLICATIONACCEPTED BY---------------------- -------- -- ------- -------- -- ----------------•----------------------- DATE------�------------------------------------------------ REVIEWED BY--------------------------------------- ----------------------- DATE .� 1 BUILDINGPERMIT ISSUED-----------=- ----------------- ------------ f�------------------------------------------------ DATE--------------- ------>v------------------------------- Alterations and/or recommendations--------------------- ';----------- ---------•-----•---------••-------_ -----------...---...----•-•---- I Ks ---------- ---------------------------------------------------------- p f ---------- --F----•--------'-----___- --•----- ------------------•----------------------------------------------------------•--------•-----•----------------- -------- --------------------------------------- - ----'1--------------•---•- FINAL INSPECTION BY:.. - ------------ Date--- ----- --------- - -- ------------------------------------------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streeti 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I E5-9-2M Revised W-2100 - -