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_ f u APPLICATION FOR SANITATION PERMIT Permit No. --- - (Complete in Duplicate) -= Date Issued .---��_?----�_---- Applica4ion 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 > /tr D ----------------------------------------------------------------------------------------- / _ Owner's Name--------------------------------- _ .1.- � -S-��G�I---1-��1- - -------------- Phone__h_=e---� M Address----------------------------------••-----------------x-----------------; -------= r --_------------------------------ Contractor's Name.. = y .�-------•--------------- •---•------ .._.__ .-1Phone._-. Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel M1❑ Other ❑ Number of living units: _WCommunify � Number of bedrooms .-_1-Numl:er.of baths .�____ Lot size __-_______--115—'.�CU_Q____-___-___________ Water Supply: 'Publics stem system Private .De th to Water-Table _______ ft. pPY� Y Y ❑ ❑ P , Character of soil to a depth of 3 f4+: Sand ❑ Gravel L] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No Y New Construction: Yes Y No ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic'+ank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well stance from foundationY_ZD________.Mater�al____ --__ -__ __________, - _ No. of compartments--------------------------Size--0— -----Liquid depth-----___--_4 y______Capacity__-- ---Q-l1--- Dispos I Field: Distance from nearest well-/-"" -z_ -_Distance from foundation____ ________ Distance td�nearest lot line---_.__------- Number of lines------------- --------------------Length of each line------ -------____--_.Width of trench----------y __-____-_-_-- Type of Cter material_ ____-----Depth of filter materiai-----Iti.___.-___Total length--__ ._ ._wt, Seepage Pit: Distance to nearest well_______________------Distance from foundation-.___................Distance to nearest lot line------ ❑ Number of pits----------------------Lining material-,--------------.------Size:IDiameter----------'---_-------Depth---------------------- ---------.. Cesspool: Distance from nearest well_______________$Distance from foundation:,..------------ _Lining material-------------------------------------- 0" Size: Diameter-------------------------------------Depth------------------.----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----___----------------------------------------...Distance from nearest building---_----------------------------_______-_. ❑ ._.r.: Distance to nearest lot line_________________ ______'-_ - Remodeling and/or repairing (describe): - �� ----------•--------------•-----•-----••-------•---------------- ------ -----• ------ ----------- •--'-------`--.�,- '� -- _ ------------------------ --------------------- --•----- - - ------ J _ - ------------- _ ::.. I hereby certify that I have prepared this application and +hat a work will be done in accordance with ------------------San Joaquin unty ordinances, State laws, and rules and regulatiA�off Sa Joaquin Local Health District.W-- -- ------------------------------------{Owner and/or Contractor) IBy:---•----_-------- -------------- •- ----•----(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--------------- ------ w -=`= ----•--•---•------------•--- DATE----- ,.. - REVIEWED BY _ ---------------- -----`------------------------ DATE -7------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------- --------- DATE.---------------------- . Alterationsand/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 k ES-9-2-M ; --�t.Revised W-2100 r