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t.. APPLICATION FOR SANITATION PERMIT Permit No. 13..7j� (Complete in Duplicate) 1G 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. S49. JOB ADDRESS AN ,, O o7---------- •- . � -----� e--Owner's Nami •-• ----•--•----•- -- ----------------- •-- ------ ....... '..... ...---._. Phone •------. �.. Address • , a l LL o ,,�.� .// Contractor's Name------- ------- - ------- ---- -- a ----- Mtn-•--------- - •-- --------- .................. Phone.__ a( ----...-------- Installation will serve: Residence X Apartment House r-11 `Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of livin units: __1.__- Number of bedrooms . - _. Number of baths .... Lot size _.....__� .. 1 /z ........................ Water Supply: Public system ❑ Community system ❑ Private Ix Depth to Water Table -------- ft. Character of soil to a,depth of 3 feet: Sand ❑ G,raa I'q Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ NCAr Const ughon: Yes ❑ No TYPE OF INSTALLATION AND SPECOCATIOWS. (No septic tank or cesspool permitted 4f,public sew r.is available within 200 feet.) Septic Tank: Distance from nearest well..._..._I_____. ance from foundation...................Material. . -.-.__________-_.... ..._._..._______.. ❑ No. of compartments..-__ ------ ,� Ske.............................---Liquid depth------------ --:-- ----..Capacity- . i o Dis o al Field: Distance from nearest well _S.� ' istance from foundation 0.......Distance to nearest lot line___:?........ Number of lines_- .•../---------------------Length of each line......610 0 .........Width of trench Z � `. Type of filter material- -------Depth of filter material_ __•'_____________Total length.........4_O_...' .................. Seepage Pit: Distance to nearest well----------------------Yistance from foundation ....... ..Distance to nearest lot line ❑ Number of pits--- ---__-• Lintht ................Size. Diameter------- ------------Depth---------------- Cesspool: --------- --Cesspool: Distance from nearest well _-:s: .____bistance from foundation---.----------------Lining material... _--_-•._ _,_,._. El Size: Diameter----- --..--------------------------De fK _----------Liquid Ca ani .._....-- _.........gals,, Privy: Distance from nearest well-------------- ____________________Distance from nearest building.:------------------------------ El ____ __._...__ ..______.❑ Distance to nearest lot line------- ---- ------------------------------------------------------ ---- Remodeling and/or repairing (describe)________ _________ ........................� . • -----------••--------•----- ------ -- -- -------•----------. ----------------------------------------------------------- ------- --------------------------------- -------------------- ------ I hereby certify that I have preparod,this a'plication and that the work will be done to accordance pith San Joaquin County ordinances, State laws, and rules an regule04jit.,of.thq San Joaquin Local Health District. (Signed) -•-- ._.. j ----- - ---- --- -•-- -- ------.-- _- -•--- ner an /or Contractor) - f� By:.- --4-%r. -------------------••----------------------•---------(Title)---------------- ----------.................. ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on rev" side). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY--- - -- • ------------_ DATE-- ct.................. REVIEWEDBY................................-------------------------------- ------------------------------------------------------------ DATE----------- -- •--•-••- BUILDINGPERMIT ISSUED--- ---•••..•-••--------• . .----•----•------- -- -------------------------- ---•--.-- DATE............................................................. Alterations and/or recommendations:- --.._... •......................................................_.........•--.. ................................................................. -----•-•----•......................•------------------------•-••-•-•---••-. --••-------•-------••----•--•••--..._..__..... ----••••-•--•-••--...•-•---.......••••-•...... i ..........................................-_..................................................................................................-----------------------------------i........................................... FINAL INSPECTION BY:. ---- • ---. -..- Date ,_ ............................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street a {132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ESQ-A..2M Revised W-2100