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APPLICATION FOR SANITATION PERMIT Permit No. { .�_. '..... (Complete in Duplicate) Gl `} 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.A�..Z... Q ___ 97f >� ' � v �L ru—/ 7 Owners Name--------------------------------- `'� �y -t? :=r .._ _ (,/. q--- ----- Phone.. Address ��,• ------- � /��?4� �n� � .�`'�' / -------------- -------- ��=`-•- �'�--•- j-- Contractor's Name--------------------------��r ----------4:::' ------------------------------ --------------------------- Phone.. Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ ��M��otel E] Other Number of living units: .1----- Number of bedrooms ._Y Number of baths ___l__ Lot size ------,l-l---- --------------------- Water Supply: Public system ❑ Community system ❑ Private N Depth to Water Table.3--Cft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Nr Hardpan ❑ Previous Application Made: Yes ❑ No% New Construction: Yes ❑ No ❑�'u�p(¢trKi�j i�2i/�r�c,�.,, 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 compartmen'ts--------------f------------•-Size-------------------------------Liquid depth--------------------------Ca'pacitY----------------------- Dis oral Field: Distance from nearest well_6-0.'.....Distance from foundat' n-__ ______..Distance to nearest lot line .. r / / Number o� lines...... Length of each line___�G-_--_�__r. Width of trench.. . _._...._...ja Type of filter material.._�� _._ ------ of filter material------Lp._--------Total length________________ _________ Seepage Pit: Distance to nearer# well-1.0a'_---__Distance from foundation----- _Q.___._..Distance to nearest lot line----- X -__/X Number of pits__:-_-.--_--___Lining material& ____S__---.Size: Diameter____ 2.3....._.,Depth__-Z_�--__________Cesspool: Distance from nearest well_________________Distance from foundation-_-________-_-____.Lining material--:_ __-_____-__.____...__-_❑ Size: Diameter-------------------------------------Depth-----------•---------------------------------------Liquid Capacity..-.--••--•--------•------g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____--_._:............-----------.------- ❑ Distance to nearest lot line------------------------------------------------------------•------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------- ------------------------------------------------------------------------------------------ ............................................. ------------------------------------------- -------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------ I hereby ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules- nd regulations of the San Joaquin Local Health District. (Signed)----- f Z Contractor) ----------- - ---------- g C j c_ Tale Y: . •------- = -- --- (Title) -•---��--- -J. -T '&J.- --------- (Plot plan, showing size of lot, location of sy m'in relation to wells, uildings, etc., can be placed on reverse side). F D ENT SE ON APPLICATION ACCEPTED BY_------ ATE............ .___. .__._ ----------- REVIEWEDBY-------------------------------------------------------a--------- --------------------- ------------------------------------ DATE...-------------- ------------....-------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------•---. .................................. DATE--------------_-------------- ------ ...................... Alterations and/or recommendations:---------------------------------------------- ------............----------------------------------------------------------------------------------•--------- •-•------------------•-----•-------•--------•--------------•--•--------------------------•----------------------•-•••-------------------•---------•-----------•-------------------••--•------------------•------••-----------. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.------ ---------------------------------------------------------------------------------------------- -----.-------------=------------------------------------------------- -----= ------------------------------------------------------------------------------•---------------------------------------------------------•- ------------------------------ ----------------------------•------------ ------- FINAL INSPECTION BY:../_"`__,---'= -'�-- 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 I0-52 Revised W-2100