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APPLICATION FOR SANITATION PERMIT Permit No. ... .. ......... [ (Complete in Duplicate) /� q a� 1 Date Issued .... Application 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 wIrC_ounty Ordinance No. 549. n �JOB ~ ' ADDRESS AND LOCATION.......---------------------------- _� --- - � --- - ----------------- --------------------------.--- Owner's Name........................................ alvn........T_c.----- =------------------------- _040-1 - one.-- --- t? Address . ..�---- ----- -----------------------------------------------------------------------. -- ---- ------ -- --------- ---- Contractor's Name................................. -•-• e..-----------------------••----...------•--- Phone..._.9.n.9-.6-0- ' .9_. _0_ --- Installation will serve: Residence D( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I_____ Number of bedrooms .2a__ Number of baths ---L Lot size'115-19 r -/f__p_'_____________________ Water Supply: Public system.6 Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No JK New Construction: Yes [] No ❑ `a�o/'PF►�¢,gr;� `je 09f�7,-7;70- TYPE OF INSTALLATION AND SPECIFICATIONS: `/ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tank:, Distance from nearest well---RQ!_c_Distance from foundation. � .......Material_-_-___-__________-_ ___-_--•_________________ '�♦ UNo. of compartments--------•-----------------Size---------------------------- --Li Liquid de th-------------------------Ca acitY----------------------- Disposal Field: Distance from nearest well-HQN.P_Distance from foundation.--?-..........Distance to nearest lot line......_+-'`_--77 Number of lines........... ---------_ _______Length of each line......2.o__,5''_________.Width of trench-----MAY''_-__-_______-__ Type of filter materiaL.tfZ"_ -.Depth of filter material _____1_3_'- --------Total length......... --------•..-_----_-__ -� Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_•__-_.__________ ❑ Number of pits----------------------Lining material--.--------------------Size: Diameter-----------------------Depth-_--------------------.----_.---. Cesspool: Distance from nearest well____•--.__..____Distance from foundation--------------------Lining material _.______-___-__--____-_____.______ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building------------------------------------------ El Distance to nearest lot line------------------------------------------•-----_-------_--•----------------•-------•-------------------------------------------------- Remodeling and/or repairing (describe):--------- ------------------------------------------------------------------------------------- ................... ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify I have prepared this application and that the work will be done in accordance with San Joaquin_County ordinances, State (a s, a rules and r lations of the San Joaquin Local Health District. (Signed)--------------------�Zt��k --- ------------ ----- --- --- , ------------------------ Contractor) r By:.............................................................----------------- = (Title) �'+43 �t"x l ! >v, P---c.------ -- (Plot plan, showing size of lot, location of system in rely on to wells, buil ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.(;•----------------------------------------_--------------------------------------------- DATE�f REVIEWEDBY-------_---------------------=?�----------- ---------------------------------•---------------------- ----.. DATE-----9r�'............................................... BUILDING PERMIT ISSUED -------------------------------•-------------- ------ DATE----------e--------------------------------------------- Alterationsand/or recommendations-----------------------------------------------------------•-------------------------------------------------------•---•-----------•---------••-------•--•-••-. ............................................................................ ----------------------- ------------------------------------------------------------------------------------- -----•--•- .................. -------------------------------------------------------------------------------------------------•---------------------------------------_.........-------------------•----------------------------------------------- FINAL INSPECTION BY------------ -- _----------- Date--- ' '� j !�/ ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 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