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j-/ .TAPPLICATION FOR SANITATION PERMIT Permit No. - __ . vo ,'� (Complete in Duplicate)"\ �� r� 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 with County Ordinance No. 549. �- ? ... ----- JOB ADDRESS AND LOCATION3. 0� Owner's Name------------------------------------------ ------------I----------------------------------------- Phone_ ? pj_.,6__jr..-- Address--------------------------------------------------- e Name.................................. ----------------------------------------------------------------- Phone---Q-_-f-4-4:?--------- Installation will serve: Residence 1. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 s.?_-_ Number of baths ---/-- Lot size ____�0----�__/!D_"----------------------- Number of living units: -__.____ Number of bedrooms%? Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table ADft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ig Hardpan ❑ Previous Application Made: YesX No ❑ New Construction: Yes ❑ No ❑9 712_P� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic 141kr Distance from nearest well_________________Distance from foundation_--___-_-----__-_.Material-_-_-.-_-----.__--_---_-.--_-_-__-_-.----.----.-. A--j No. of compartments--------------------------Size--------------------------------Liquid depth------------ -------.-Capacity----------------------- ''V oDistance from nearest well..----------------Distance from foundation--------------------Distance to nearest lot line------........... sa sa *- Number of lines-----------------------------------Length of each line-_____-__--______.__..._-.___.Width of trench-----------------------.----------- %4) Type of filter material-------------------------Depth of filter material-----------------------Total length---------------------_----------------- W SeepWe Pit: Distance to neare t well-A-0-i_Ez.._.Distanc fr foundation__�Q__.........Distance to nearest t line:_.g_---_.-._ p ------------ --- --- Number of pits_ ._________.._-___Lining mate ria _ __.Size: Diameter_ _��_._.-De th�f� . 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..____-_--__---.-____-__-_--.---..-.-.-. ❑ Distance to nearest lot line ------•---------- --- -------•-------••---------------•------------•----••------------ -------------------- jarRemodeling and/or repairing (describe):_.--_--_ '� .-----.-- -�-_-- ------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby crt at I have prepared this a plication and that the work will be done in accordance with San Joaquin County ordinances, Staand rul s and gulation of the San Joaquin Local Health District. (Signed) ---- -------------------------- - ------ --- ---------------- (� Contractor) - - ------ --- -- AIW By:-------------------------------------------------------------------------------- - -- -----------(Title)--- c`; ( t►'� Q f2. : (Plot plan, showing size of lot, location of system in relafi to wells, build. s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- ------ - -- - ----------------------------------------------------- DATE-------. --r-------------------------- ---------------- REVIEWEDBY----------------------------------------- ----------_------------------------------------ DATE------ -- - -------- BUILDINGPERMIT ISSUED.............. -----------------------------•------------------------------------------------------- DATE---- ----------------- ---------------................. Alterationsand/or recommendations---------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------- ---------------------------------------- --------------------------------------------------------------------------------------------------------------------------•--------------•------------------•----------------- ---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------•------ ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ -- ;''7 G�' cam'' FINAL INSPECTION BY:---------_---•------"------------------------------------- Date---.�1-- �� 3 --- --------------------------------- 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 10-52 Revised W-2100