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APPLICATION FOR SANITATION PERMIT Permit No. _2✓�'.3 _ (Complete in Duplicate) I � 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. 549. JOB ADDRESS AND LOCATION. <310 S '=' t �" Owner's Name _`4L°i44�1.li1�./_--------- ---- ------------------------------------- Phone-----------•------------------------ Address------------•---•-------..-1-� .1 Contractor's Name......................( ----------------------------------------------------------------------------------------------- Phone-------------•-------............ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�____ Number of bedrooms __2.,. Number of baths -------- Lot size ____ ........................... Water Supply: Public system"*5<Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�E] Clay Loam ❑ Clay ElAdobex Hardpan ❑ Previous Application Made: Yes ❑ No x New Construction: Yes�j No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__,______________Distance from foundation--------------------Material------------------------- ❑ No. of compartments--------------------------Size------------_----------------Liquid depth--------------------------Capacity ---------------- 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 well----- ----------------Distance from foundation_.................Distance to nearest lot line_________________ ❑ Number of pits______________________Lining material-----------------------Size: Diameter_____________ ______--Depth _________-__-__------_--._---_- I: Distance from nearest w II_________________Distance from foundation I_0..........Lining material______ _ Cesspool: Size: Diameter-__— -. -____De th______r1?____--- _-__ --- -- ---- - --____Li uid Ca acit Y----,-------------•-------gals. Privy:': Distance from nearest well-------------------------------------------------Distance from nearest building____. _______________________________ � ❑ Distance to nearest lot line-------------------- ----------------------------•-------------------------------•--•------------------------•----- ---•----•----------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------- -------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- -----------------------------------------------------------------------------------------------------------•----------------------------------------------------------------- ........................................... -------------------------------------------------------------------------------------------------------------------------------------------------------------.-----•----------------------------------- I 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. �' n (Signed)---�"Y. 3/__ tib:L,,-- .. -: L � ---------------------------------------------------(Owner and/or Contractor) By:------------------------- ------------------------------------------------------------------------------------------------ -----(Title)---------------------------------- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - --- - ------------------ -------------------------------------------- DATE............. -- - - - ---- --------------- - REVIEWED BY - - -------= - - ----------------------------------------------- DATE PERMIT ISSUED..................................... - ---------------------------------- DATE------_�--...... --------- -- . ----- •--------- Alterations and/or recommendations: ------ --------- ------------------------------------- -......------------- �j j --------------------------------------- ........................................................................... ......... E ..........................................._-________-___-___.._--__-___-_-._____. --_-_-_------------..................................................................................................................... ________________________ __ _______ _____ ___ ---.............- ---_...._-__ -___..- -------------------------------------------------------------------------- --------------------------------------------- r , f�FINAL INSPECTION $Y:. -_--------- ;r----------------- ------- Date--------- ------------------/-------------------------------- 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 145446ATW000 12-54 1