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APPLICATION FOR SANITATION PERMIT Par it •' (Complete in Duplicate) $/ / Date Issued ---------- A is hereby made to the San Joaquin Lo Health District for a permit to construct and install the work herein desc//////ribed. This application is made in compliance with, rdinance No. 549. ! JOB ADDRESS AND LOCATION-----------7-7- _ - 'v '`k `�'A- 3----------------- --- - - -------------------------------------------------------- Owner's Name_ ( .tl' S-:r.v w--�-------------�--------------------------------------- iPhone----��-`--`-'�-�-�---�----- .. Address------------- --�__7 � + " �� ----------- Contractor's Name_______________ --�----4—. ----if--�--�-a--�--�=--�---------------------------------------------------------------------------- Phone'-----�`=--�-`-f Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other Ej Number of living units: Number of bedrooms ___Number of baths __ rr " Lot size ----i P-- y,----ad Water Supply: Public system �I Community system ❑ Private ❑ Depth to Water Table -- Character of soil to a depth of 3 feet: Sand El Gravel ❑ Sandy Loam ❑ Claym loa ❑ Clay ❑ Adobe[id Hardpan Previous Application Made: Yes ❑ No ❑ New Construction:.Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r ti (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 eptic Tank: Distance from nearest well-------- Distance from foundation__--_______.__-- Material___ _,_______________-________._______-�l No. of compartments___---___ ________-Size_ ----------Liquid depth------------------------- DisposalCepacitY Field: Distance from nearest well_ --Distance from foundation__ - of each line______ ___---------- Width of trench------ - --------------------- Type of filter motorial____ _ _ p �� �� De. th of filter material _-----Total length-----.��__.':-}-•-__--- Seepage Pit: Distance to nearest well___.__ ~ 1 -------Distance from foundation___--/_ _ __..Distance to nearest lot lane__ . __._._ Number of Pits----------- ________Lining material---13—R-1__Ea.. -Size: Diameter__--_ i ---------Depth---fes!--- Cesspool: Distance from nearest well-----------------Distance from foundation----------•---------Lining material---------------------------- El Size: Diameter------------------------ ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 4 Privy: Distance from nearest well_________________________________.-------------Distance from nearest buildingEl Distance to nearest lot line________________________________ Remodeling and/or repairing (describe):------------ - -- -- ,-f __._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)--- qkl ,_t_ `ill,------ ------- (Owner and/or Contractor ---------------------------------------------------------------------- .- (TitlTitle _ e)--(..crz c "- ).1 -------------- — (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---- REVIEWED 1 Y_i_;_:._------------- REVIEWED BY-------------- - ----------- ---- ----'-- ---- � - � �------„ •- ------------------------------ ------ DATE ...................=---------- --- ------------------------------------- 1LDING PERMIT 155UED __ ____ -------------------------------- =----- - ----------- ---------- -------- DATE--------------------- -Alterations and/or recommendations: '--------------------- ------------ -------------------------------•-----------------•-----------=----------------------•------------- ------•--------------------------------------------------------------•--------•---•----- ---•------- ----•---•--------------------------------------------------------------------------------------------------------------------------------•----- ---------------------------------------- ---------------- - FINAL INSPECTION BY:______. --.- r` ----"k4L_ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street . . � 132 Sycamore Street 814 Nor+h "C" Street Stockton, California. Lodi, California Manteca, California Trecy, California ES-9-2M 8-51 Revised W-2100