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APPLICATION FOR SANITATION PERMIT Permit No. .4.................. V g,4 (Complete in Duplicate) r1 � Date Issued .___ .___�.��5.3 Application inti 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 Or •nance No. 549. JOB ADDRESS AND LOCATION....__ �. Owner's Name..................................... ------ � -r...... --- - - - ----------------------------------------. Phone----si3--2-Y. ----- Address---------------------------------------••--------- `� 7 ! ----------------------------------------------------------------------------------------------•----------- Contractor's Name........................... L, Ott—- - ------ -----------------•-----------------------•-------•----- Phone----------------------------------- Installation will serve: Residence Q!� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/------ Number of bedrooms .1-1 Number of baths . ..__-_ Lot size ___,6_6— ------ __.1_ Q_______________ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table _-h40ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lL Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑J �¢�,Qa„,.,. i TYPE OF INSTALLATION AND SPECIFICATIONS: �t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___O__.P ----Distanc from f uncation--ion-J-0-----------..,��' -'} No. of compartments-__-- ----__-_____Size_�Y ---a�f- _Liquid depth_XV__"-------------Capacity_A.;9._--__-..-- Disposal Field: Distance from nearest well__,-__.---------Distance from foundation....................Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line----------.-------------------Width of trench--------------------------------- __ Type of filter material-------------------------Depth of filter material-----------------------Total length___--__--___-------.--.--____________-__-. Seepage Pit: Distance to nearest welJRf q----------__Distance fr m foundation__Z4' --------Distance to nearest lot line___ _____ Number of its----- 9 i G0�� --- J__ "--------Depth--__7,_X_'0 ---------------- p' rf_._.._.__._ Linin material_________ _ Size: Diameter._. 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------------------------------------------ ElDistance to nearest lot line-----------------------------------------------------------------------------------------------•--------••-•-----------------------•--- Remodeling and/or repairing (describe)----------------------------------------------------------------------------•--------------------------------------•------------------•--------------- -------------------------------------------------------------•----------------------------------------------------------------------------------------------------- -------------------------------------------------------- ------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------•-------------------------------------------------------------------------------------------------.----•------------------ ------------------------------ I hereby certi that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State a s, and rules nd regulations of the San Joaquin Local Health District. (Signed)--------------- ------ --------- ___,1-------- -----------------•------- ------------------------------------------------( 'w Contractor) By:--- L -----------------------------------------(Title)--- u at..�.l---------------------- (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------------------- __ _ - DATE BY------ ------------------------------------------------------------------ ----------------------------------------------- DATE--------------- ----------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------................ Alterations and/or recommendations:................................................ ...__.....__..___......._._..._ --------------------------------------------------------------------------------- . ----- -- ---- --- --- ................................. ----------------------- --------------------------------- -------- ... `....' - --------•------------------ -------------------------------------------------------------- `'?� ►tea #� - --------- ---------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- -•---- FINAL INSPECTION BY:-----------------Gf._ '` ` 2------ Date--------- � F .✓--------------------------------------------- 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 0-52 Revised W-2100