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U APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ... Applica+ion 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. 6 �. a_�_-_ �.. - _ - Owner'sLS ----•--------- # - Phone__ Address------- - --------------•-•----------------------------------------------------------- ---- -------- ---------- Contractor's Name__. ... C�1 ' `` ---------------------- ------- ----------------------------------------------------- Phone---W-6-4--Z- Installation will serve: Residence,0._Apartment_House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -__ Number of bedrooms ----2 Num; ber of baths __ p �+° _�- ± � fcl�r 7x166 Number of living units: 1;_____ Lot size !11 Water Supply: Public s-stem'A Community system # ~ y y y, ❑ Private ❑ Depth to Water Table .---____ ft. Character of soll to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 0New Construction: Yes)K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet] Septi Tank: Distance from nearest well__h_6)V •__Dista r m foundation__.�_�' �h..Materiai___ __ `� woo_ -------- No, of compartments--___�______________Size_____ �i �CVLiquid depth_ L�_,-._._ Capacity --- ��r�•• Disposal Field: Distance from nearest well) ntfDistance from foundation__�_r..0P./-il-Distance to nearest lot line____a1. '!y/ Number of lines___-' ---------------------Length of each line--------7©f__ Width of trench.__ Lt. ------------- --Type ---- „_Type of filter material__5!7R9_r�-__Depth of filter material___:f!5�__�______Total length___-..._- -_ ©___________________ i Seepage Pit: Distance to nearest well------------- -----.__Distance from foundation---------------------Distance to nearest lot line_______.___:---.- ❑ Number of pits------.---------------Lining material•----------------------Size: Diameter----------------------Depth---------------------------------- W Cesspool: Distance from nearest well__ _____________Distance from foundation--------------------Lining material__..____--_-__-.---- _____________--- _..__________-_Liquid Capacity gals. ❑ Size::Diameter-------------------`�1------'--------Depth- ------ --- --------=------------- q P Y----------------------------9 Priv t Distance from nearest well ��_____________________ __ Distance from nearest building _____- ❑ ~_rt ----------------- - '-' Distance to nearest !at line 4 O Remodelin 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 Coun ordinances, State law rule---- s anrd'',,A�66uu6---'-''v - _lafions of the San Joaquin Local Health District. or ----- - (Sign ed)--- -------- Contractor) B • IJ (Title]--- : Y• --------------------------------------- (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----- --- -----------------------. , ------ DATE,-;,/�G/-� `;r- ---------------------------- r. .. -.- - --- - '' =`-------------- DATE---------•- - REVIEWED BY ---------------- ---- ---- = .�*. BUILDING PERMIT ISSUED---------------------------------------Y --------_%---------------:`.::r,"._4r==-- L}-DATE_.-.---------------y------ _, �,, Alterations and/or recommendations______________________________.._____._ _._.____________._--- -_ ^ ------------ ---------------------- f , ----------------------•----•--------------••-•----•-----•-•-•------ _ - -- = s ,. ....�.s.y�.. -----------------------•--- - ---------------- FINAL INSPECTION BY: .._ Date-----------! - S 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 ; Revised W-2100