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�. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 LOCATION:...: �L�!`3 1 -77►��1 _ '�4 r r --- Phone--A/- Owner's Owner's Name-------------------------------- ' / f� _1 _./__ �� --- -------------------------------------------- Phone �------:..-�--- - - .`�` �w Address...................................................------ r ---------------------------------------------------------------...----•----------------.--- --------------------------------- Contractor's Name..............................................fg- -Y-�-.-------------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court ❑ Motel F] Other [3 Number of living units: -------- Number of bedrooms _1` of baths I..__ Lot size ---------- ----------- .-g___---_--- Water Supply: Public system A,Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No9 New Construction: Yes r1V No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank- Distance from nearest well---_`-------Distance from foundation---/0/------.Material------ �� t '>y`7V' No. of compartments_....___`�"____.__.__Size__JX_9_4�_-Liquid depth--._-___4L_'Q_`�_Capacity_-______-__-_.-__-.-.- Dispos I Field: Distance from nearest well_____.-'�__._Distance from foundation....��....__.Distance to nearest lot line.--- /..... Number of lines_____________�---------------Length of each line_-_.._-- _V---_� ----Width of trench--------2._`+�"._`........ Type of filter mate ria l __R* __.Depth of filter material-_---_-!&__-----.5jo _Total length__________________- 0..._....__._ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line__.._.-----_-_-_- ❑ Number of pits----------------------Lining material-..__----._-._._-__.--.Size: Diameter-.-,--------------------Depth_----.-___-.-----_-..______-.---- .y 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------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------- .............................. ---------- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------•------------•-------------------......-------------------------•----------------------------------------------------- -------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)j---.... ' f " ----------linhafion –' ------------------------------------------------------7---- .------------(Owner and/or Contractor) By:-------_--------------- -------------------------------- ------------------------------------------:-------------(Title)---------------------------------------------------- ----------- (Plot plan, showing size of lot, location of systeto wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------ -- -- DATE----------- t REVIEWED BY------------------------------------- -------------------------- -----............ DATE-------------$..._ .............................. �:u -� BUILDING PERMIT ISSUED........................ ---------------- --------------------------------------------------------- DATE------------------------_------------------------------------ Altera 'ons and/or recommendations:--------------- } -- -------------------- - -- --- ------------ ---- K.,-ea.. alt----- -----------------.......................... ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-- - ------------------------------------------------------------------------ ------------- --------------------------------- ............ ,-..----------------------------------------------------------------_ ....... FINAL INSPECTION BY:..---- f F= Date. I ` V 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 I0-52 Revised W-2100