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`� APPLICATION FOR SANITATION PERMIT Permit No. _________ ___________ Kjt, ` (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. l---a JOB ADDRESS AND LOCATION Y- � � T........... ----------------------------- Owner's Name-----------F.---s-4----t-..--Y --------------------------------------- ----------------------------------------- Phone_d-V..5-S, --------- Address-------------------•--------------------------------- ----- Contractor's ---Contractor's Name---------------------------- A-At'1!!1&-- T 1 G r---------------------------------------------------- Phone----- 0 Installation will serve: Residence D( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - Number of bedrooms y Number of baths _ Lot size ---/0 � __��s___________________ Water Supply: Public system SL Community system F1Private E] Depth to Water Table _14 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A— Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No ❑ 5u e f ke me rv-1 TYPE OF INSTALLATION AND SPECIFICATIONS: �J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ticT Distance from nearest well_________________Distance from foundation....................Material........----------------------------------------- ew • is �I No. of compartments Size Liquid depth Capacity ------ vl Dis osaI F' Id- 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-tJ0I1lQ-----Distancl6K4 oundation__-�Q�_____.Distance to nearest lot line___w�_�_9 Number of pits_-_-I----_-•---------Lining material-CA -------Size: Diameter_- ��*---Depth_-�,5�________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth----------------------•---•------------------------Liquid Capacity-------------_------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_________-_--_-____________.-__________- ❑ Distance to nearest lot line--.--- -_--------------------------•------------------------•--------- -------------------------•--------•----------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------•-------------------------------------•-•---••••----------------------•-•------------------------------ ---------------••----------------------•-•--------•---......................................I----------------------------------------------------------------------.................................... ----•-------•-••---•---• -----------------------------•----------••--•---------------••-•-----------••-•--•----------••--•------•-••-----•-------------------------------•••••----•-•-----•...---•-----•---------•----------- ------•-----------------------•----- ----- - ----------•-------------•--------------•--------•-------------------------•--•-_-----•---------------------------------•---------------•--------------------- I hereby certif at I have preps d this applicatio �f a the work will be done i accordance with San Joaquin County ordinances, State la an rules and re ulations e J Local Health Distr' AR�c�"s lSi ned G 9 )----------------------------• --------._...---------------------------- - ----- - --- -------------- -- ---------------------------I— -- Contractor) By:............................------------------------------------------- ------- - --------- ------ ------------ (Title)---•- --- .. -•---------- ------ (Plot plan, showing size of lot, location of system in relati to a s, uil ings, etc., can be placed on reverse side). FOR D RTMENT USE ONLY APPLICATION ACCEPTED BY---V--------------- -------------------------- --------------- ----_------- DATES''�•----•------------------------------------------------ REVIEWEDBY---------------------------- ---------------------------------------------------------------•----- --------- DATE----' ................................................ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..........�"--------.................................... Alterations and/or recommendations--------- -----------------------------------------------------------------------------------------------------------•---------•-------------•-•--•----•--- ----------------------------------------------------------------------------------------------------------------------•--------------------------............................-----------••-•-•--------•-•----------•-------• ----------------------------------•----------------------- ---------•---- ---------------------------------------------------------- ----...-----•--------••--•--_..---•-------••-•--•------------------•--------_--•--- -------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------- -•---- �) , - FINAL INSPECTION BY:. ...-•--1- ------------------------------ Date_--------- ----------- - -•---------1T__.-------------___---------------•---- 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