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w p APPLICATION FOR SANITATION PERMIT Permit No: _ a S' [Complete in Duplicate) 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 Ordinance 549. 'JOB ADDRESS AND LOCATION___._----- �-jj-- - - -Q }- - Owner's Name ----- -----------M &-----.�",-'0_&_ �0-4-4------------------------------------------- Phone-_` --7-ZA Address-------------------•-- --------------------- Contractor's Name f ----- IV----------- V--------------- Phone--4�-y P-7--------•-- Installation will serve: Residence ❑ Apartment House [jj_ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,Number of bedrooms __3-_ Number of baths -S__ Lot size ---- Water _d- Water Supply: Public system ' Community system 'El Private P. Private Depth to Water Table a®ft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [] Previous Application Made: Yes E] No New Construction_ : Yes ❑ No ❑ � ` � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptiiT kR Distance from nearest wet€_________________Distance from foundation__________________.Material______________________._- No. of compartments--------------------------Size--------------------------------Liquid depth Ca acit 47N q P p Y----------------------- tU sposal Feld: Distance from nearest well_____:_________-Distance from foundation___________________Distance to nearest lot line---,------------. I Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------__ -- -------------- i Type of filter material_________ ___ _______Depth of filter material___________ -"--- Total length__________--_______-.________-_--________ Seepage Pit: Distance to nearest well__ 4Distance ro fou ation_:__ Q ----____--.Dggista if to nearest line Number of pi.ts-----I----•----------Lining material- Size: Diameter--c Depth d ------------------- Cesspool: Distance from nearest weft___------------Distance from foundation--------------------Lining material----------------------.______ El Size: Diameter ---------------Depth-------------------------------- -------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well______ ___ ------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line- -------- ------------------------------------------- ---------------------------- r Remodeling and/or repairing (describ )_----- --- _____ ----------------- -i-_____________________ r --- • ------------- ------------------- -------------------- ------------------------------------------ --------- -------------------------------•-----------•------•---=-----------------------•----•----•----- -----------------------------------------------------•------------------------------•--•------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 11 , and rue nd regulations of the uin Local Health District. (Signed)-- r l_ _ `F f -- j? r �C�o Contractor) S- -C—— BY= ... ------ - - --- --(TitleP- I��?]--f )_I1 ------------- (Plot an, showin size of lot, location of sy em in r ation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY PLICATION ACCEPTED BY- --------------------------------------------------- DATE- ------ REVIEWED ----------------------- --------------------------------------- BY------------------------------ -- ---------------- ------- ------- - ------------ - --------------- -------------- ----------------- DATE----- - BUILDING PERMIT ISSUED----------------- --- ---------- ------------------------------------- --.------------------ DATE- - Alterations and/or recommendations:_______._ __ ------------------------------------------------------------------------ ------------------•-------------------------------------------------------------------------•---------------------------------------------------------------------------------•-------- ----------------------------------------------------- FINAL INSPECTION BY---------------------- ----- ---- -------------------- Date------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M 8-51 Revised W-2100