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2 � V APPLICATION FOR SANITATION PERMIT Permit No. .: .. (Complete in Duplicate) } ,/ Date Issued Applica}ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance,No. 549 JOB ADDRESS AND LOCATION.-P-Z. 4- _,�,Name. _ 11. ------AD... - -------------------------- Phone------------------------------------ Address4!10........ ;--• •. ---•--.... ----- -• -----•-- --------- ----•--..._....----•-•---------- . - �,,�� Contractor's Name ' ,�i l,. '�elI. Phone � ,t:' ..... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..._. Number of bedrooms ___2--Number of baths _ .... Lot size ._�b.__�__::_[!�._a_-_•_-_--•-----•-____-•- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -.------ ft. Character of soil to a_depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe ardpan ❑ Previous Application Made Yes ❑ No❑ New Construction: Yes ❑ No 11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) *Sep Z-an r Distance from nearest well-________________Distance from foundation_-_.._....._......Material ____-. _ --_______-_-•--._____--___----.No, of compartments----- ---- ------------Size._...._--- := Liquid depth.;,- ..........._._._Capacity._._____.__-_....._..._ al Fie Distance from nearest well------------------Distance from`foundation....................Distance to nearest lot line................. Number of lines-----------------------------------Length of'eacTi line---------------------:.......Width of trench................................... Type of filter material..._ --------Depth of filter material-.___-__-___ Total length.......................................... p� Seepage Distance to nearest well ----_._---Distance from foundatjon ....... 3istance to nearest lot line Number of pits....— ------------Lining material.__._ .._ _......._Size. Didmi6 _-:-----• -- ---Depth--------------------------------- Cesspool: ---- ---- --------- -•---Cesspool: Distance from nearest well-----------------Distance from foundation:__.____. __.....,Lining material-------................................ U ❑ Size: Diameter-------- ------------------------•---Depth---•- . -------------------- ........Liquid Capacity........................ ..gals. v Privy: Distance from nearest well �-.------------------------------------------Distance from nearest building ❑ Distance to nearest]ot line----------------------------------------------- ------- -------- -------- ------- -- ........... -•--------------- Remodeling and/or repairing (describel :* �i'�'�'7 . •-- ... ....................... ....... ..... ............................ . .. . . ...............------------------------------------------------------------------------------------------------ ........................................................ ------------ - ------------------------------------------- ------ ----- ------ ------ ------- ------ ------------- -- ---... -- ----- -- ----------------- -•---------- I hereby certify that 1 have preparfsdAis-application and that theworlvwi# be done-tn-accordance with San Joaquin County ordinances, St laws, and rules and regulation; of the Sen Joaquin Local Health District. (Signed) 4.. ...y'- •�.. ---••-----•- . ---- Ov ter llor.,Contractor) By:............ ---_-- •. . --------- _-......(Title)-- '----- ---------- (Plot 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 _ DATE �� REVIEWED BY -------- -------- -------- - DATE f -- - ---------•--------------- ./_..--•-• .•---.c•: BUILDINGPERMIT ISSUED....--......•-• -•---------••. ----•---•---------•-•-----............-•-----•••----- ....... DATE........................................... Alterations and/or recommendations:..................................................................................................................................................... ------- -7 S FINAL INSPECTION BY:- o f =''� �... v.. " / --- --- - ----- ------------------- 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 Revised W-2100