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No'. 1 APPLICATION FOR SANITATION PERMIT Permit N (Complete in Duplicate) � Date Issued 1" 1 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 CountyOrdinance No. 549 JOB ADDRESS AND LOCATION............... o 4 --&(J --- -t--- `' -------- --'� '`'_ ----------------------- wner's Name------------------------ --- ` K- - ------ Phone.... .'"..2_4_.3'1------ Address--------------------------------------------------------- -----Address-------------------------------------------------------- t Y E-- .----------------------- -- -- -------------------------- -------- Contractor's Name....................................... _�_ ' >_ -s.G _�'-------*--- * Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms __ _ Number of baths _ -___ Lot size ____l_ _ . ''-__t __ _----________________ Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ .Adobes Hardpan ❑ Previous Application Made: Yes ❑. No X New Construction: Yes ❑ No ❑ ,- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,Wptic-T Distance from nearest well-----------------Distance from foundation--------------------Material_____-___--.-_.-__________________________-_,__- s� '`- 1 n. No. of compartments--------------------------Size----------------------- -------Liquid depth--------------- -------Capacity----- ------ ----- Disposal Field: Distance from nearest well, ----._.Distance from foundatio ----------- -----Distance to nearest lot line_.a. _______.__ Number of lines____________ _y��_______-__Length of each ---------Width of trench _+Z__'j_`_ Type of filter mat erial----_-___27__ ----Depth of filter material----/N"---.__Total length.._6 _ _______________________ Q ` Seepage Pit: Distance to nearest well---------_----------Distance from foundation -----------------Distance to nearest lot line___________-_____ ❑ ,.,Number of pits---- ------- ----Lihinq material-----------------------Si ze: Diameter------------------------Depth ------------------------------ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---------.__________-________--__-___. pSize: Diameter--------------------------------------Depth.--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___._____________________-____--__--__._. ❑ Distance to nearest lot line----------------------------•-----------------------------------------•--------------------------------•------------------------------ s „ --- Remodeling and/or repairing (describe):-----------------_ -------------------------•------------------------------------•--------------------------------------- v) ----------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------•-------------------------------- -------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------•---------------------------------- -----------------------------------------------------------------------------------------•------------------------------------------•--------------------------------------------------------------------------------------- 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. (Signed)- ' 1 Fi__ -.54.--- r t_2r--------------------------- - ---- - ---- -------- Contractor) --� BY� ----� — - (Title) ��n i 1t= 1 i i C . (Plot plan, sh6wing size of lot, locaon of system in relation to wells, buildings, etc., can be placed on reverse side). PA USE ONLY // APPLICATION ACCEPTED BY__________________ •. , DATE_________T/.,C_ _ ___� ____-_--_- -------- REVIEWEDBY-------------------------------------------------------- -------- ---`-�-- ------------------------------ 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 8-51 Revised W-2100