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APPLICATION FOR SANITATION PERMIT Permit No.4I- .f _ (Complete in a Duplicate) Date Issued _ .........._ App ica+ion is hereby made to the San Joaquin Local Health District fo;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..__ _-_� C� -----�-------------------------------------------------------------------- -_ _ / ---------------------------- Owner's Name e .i — tai--------------Address Phone--Aa C1.- /�a�— --------- ---- ----- -------------------------------------------------------------------------------------------------------------- 4,<,lontractor's Name = � 4'.I----------------------- ------------- -------------------------------------------- Phone----:7�'-"=== Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mots ❑ Other ❑ Number of living units: __�____ Number of bedrooms'$/Number of baths ---I---- Lot sizeb6 ------ ------ Water Supply: Public system ❑ Community system ❑ Privat Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel E] any Loam ❑ Clay Loam ❑ Clay ❑ AdobeN Hardpan ❑ Previous Application Made: Yes ❑ No,K, New Constr�x sri .r ely' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - ` s (No septic tank or cesspool permitted if publics t is eva - Septic Tank: Distance from nearest well-- , ., _ [}nstan f /n Ma# ialS NO of:.cotxlpartmdnt� -� Size.:� ��Cf r � a - - v `r z Disposal Field: +am, n8ar eve!& so. - Distance from foundatii000n- _ _ _ Length of each line_________ ___� . Width o��rencli --•.-_____: -- - ' fYP filter mdtt{iat_a'► [ cc r,i1 1 \ Depth of filter material__ _------------Total length---- Seepage Pit: Distance to jj-' r— g if ___ _____ ______Distance from foundation-----------.--------Distance to nearest lot line___________.____. ❑ Number `" „F t. --------------Lining material--------------- --------Size: Diameter--------------------- Dep th WCesspool: Dista --------------trearest well-----------------Distance from foundation-__--___-___.-_.Lining P material---------------- F] ---- a #� . D ___-_-_--___ ____ 00 Privy= ----- p ------ -------- --------Liquid Capacity----------------------------- ❑ gals. . '�rom nearest well_-__- __---_____-___-_____------------------Distance from nearest building to nearest lot line -- -------- fi: --------- --------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------- , i ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------- -------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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)...... t�-- -------------------------------------------------------- ------(Owner and/or Contractor) B (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___ REVIEWED BY - L,- ---------- DATE----- BUILDING PERMIT ISSUED ----------------------------------- ----------------• DATE -- --- . -•------ -------------- ---------------------------- -- gJtera�#ipns ar�d/or ommanda ns _. ___ dE -------------- zy ti Al i `n r t ) ---------- ---- ------------------- ------ FINAL INSPECTION BY:_._-._-_-_-- ---__• ---------y � 1� _ _ s-L/ �---- 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 Traey, California ES-9-2M Revised W-2100