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APPLICATION FOR SANITATION PERMIT Permit ...... r `© (Complete in Duplicate) Date Issued! _ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her# described. This application is made in compliance with County Ordinance No. 5449. JOB ADDRESS AND OCAT ON._-- ----1C?�..------.4EA-S.�------- Rr------------�-w d,-.......---- ' � .............................................--------------------------------------- Phone)W._r.X7�0�?._/-__7-- Owner's Name........ .t. .............. Address._..-•-•••-•--•----•••---• •-•--- , eta f111.Aroo_..._.. .------------------------- / / ..... Contractor's Name---------_---- 1z 1S1 ---- -------------------------------------------•---•----•---------------•-------- Phon�-!Q ,Pi 7------- Installation will serve: Residence 10 Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms Number of baths I....... Lot size ---lQ 0_*X APAO......f______________________ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table A57`ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No $_ New Construction: Yes ❑ NoX 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------------------------------------------------- ❑ lit No. of compartments-----._---- ------Size................................Liquid depth__-.. _-----------.-.---Capacity-----.-..----------.--- Disposal Field: Distance from nearest wel ,3, - _-__Distance from foundation....�0._-__._.__..Distance to nearesi lot line.S`-....... Ek Number of lines....Q?'«y_it---------------Length of each line--_.�f>_��c_�l__...____.Width of trench--7-4'1 -�______.__..______-- Type of filter material.�_.y--- 01<t_____Depth of filter material---�_Q____----------Total length....41____--__---____--__-.___.-__- 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-----------------------------------.._... ❑ Distance to nearest lot 'ne----------------------------------'-----------------------------•--------------•---------•------------------------------•-•-------------------- Remodeling and/or repairing (describe . 1.9_ZA/_____�_____..�� __._.�_�`�;.��1�M_..... s�/l�1S��,,,�..•�� A N 1CSle4 11 7"R6,t t2 N -- Q.tk4/t1l i4S ,P,�—i419 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I , an ules and regulations of the San Joaquin Local Health District. (Signed)------------------ !�� !.�y �,=•�----------------,{`- --------- ---- =1--------------------------- (Owner and/or Contractor) ---- By:.............. ....... - ----------.1� ....--- -- . •. . .--• ....................(Title)---- ' - - -- --------------------------------------- (Plot plan, showing si lot, location of system in relati n to wells, buildings, etc., can be p a d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DA __------------•----------------------•------------------ REVIEWEDBY.......................------- -------------I----------------------------- -----• DATE.;.&.................................................... BUILDING PERMIT ISSUED----- !---------------------------- .....--•-------------•--------••---• DAT .`-”' *...•-�........4-------------------------------- Alterati and ecommendations... "I d - ------------- -- ` ....}..� ----------- ----------• ) _i- ' - _1._.... .. } �.rrL:.-_ >w �_xti --- .................................. . -------------------•-------- FINAL INSPECTION BY:......(/__.f/ �` �Z'�................. Date..:._...._.___ � .-ev 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 Revised W-2100