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APPLICATION FOR SANITATION PERMIT Permit No. a ''6y n V (Complete in Duplicate) _ --,x 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 Or finance No. 549. ` 1 QQ'' ---------------- - -----------•------=---------JOB ADQRESS AND OCATION------Lt_. �-----Zr_t ------- -- - - ----- - ------&_ ,-- --=--=.:.-----....-- Owner's Name----------- ---------- - - - ----------I---------- - ------------------------ --`--------._ Ph o % �J-- 3.. - �.P�r-y- '� � ... . ----- -- - -------------------------- Address_ -- JJ Contractor's Name------------------------------ ----- ------- ----------------- 6 Phone,) -4--N-4-7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _',_._ Number-of bedrooms _o�. Number of baths �__. Lot size ____ _. ______________________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table _11.J ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ❑ Clay Loam L) Clay E] Adobe Hardpan ❑ 1 Previous Application Made: Yes ❑ No New ConaZi� s No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Septic ank: Distance from nearest well-----------------Distance from F ❑ - foundation_____________'______Materia--------------------------------------------------- N _______ ______________ .______-_______-_____._. Natmartments-------------------------Size-------------------------------Li Liquid de h-- ------• - --------Capacity =of comp t Disposal ield: Distance from nearest. well-_f[9-d__._Distance from foundation �a --,=___.Distance to nearest lot lin�--#- _.__-_ ' Number of lines------------ ___-- Length of each line l�---`--d-- -,t+__--.Width of trench----��-- -------------------- f T ae of filter material,�1 -Depth th of filter material------- Total length________J�Q____ __ i YP� P yA Seepage Pit: Distance to nearest well_____----------------Distance from foundation___.__________-____.Distance to nearest lot line______.:_________ ElNumber of pits------- -------------Lining material-----.-----------------Size: Diameter---------------------------Depth_----------------------:--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----._____________._______r____---- ❑ Size: Diameter--------------------------------------Depth------------------------------------------------;---Liquid Capacity-.--------------------------gals. Privy:" Distance from nearest well-----------------------------------------------.-Distance from nearest building.___-.._______________________________._. _ ❑ _ ,. Distance to'nearest lot line__'-;.- -------------- ,-..- � ; -- 1 Remodeling and/or repairing (describe): ----------------------------------------- ------------------------------------------------------------------------ - °-------•--••---------------- ------------------------------------ ---------------------------------------------------------------------- I ----------=---------------------------- ----------------•-•------------------------------------------------------------------------•----------------------:------------------------------------------------------------------- I hereby certify•fhat 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, i [Signed)---------- -- .6--- ---------------------------- Contractor) By:.....-------- -------- -•---- y --------------------------- -- ------------------ -= `._ ----------------(Title)---- - - -----• ---- -- ------ ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i E t 'FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY-------------- --- ----------------'--------------------- DATE------- �-,---- --•---------------- REVIEWED BY-------------------- ----- ; DATE = ! y i BUILDINGPERMIT ISSUED-------•------ ---------------- - ---------•---------------------------------------- ------------ DATE--------------'- Alterations and/or.recommendations: - ------------------------------••----- -•-•----•---------�--•--•-----••--•--------------------------------------------------- .-.----•----------•---------------------------------•------------------ ---------------------------------- 1 : „ -----------•---------------------------- --------------._---- ----_ --•----------•------------------- --------- ----------------•----------•--------.---------------•--- FINAL-INSPECTION BY:------ --- _y, Date_.---------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Sfr a 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