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40 �21 APPLICATION FOR SANITATION PERMIT ,,G`'� Permit No. ________________________ (Complete in Duplicate) Als-.5— 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 Ordin nce No. 49. JOB ADDRESS AND LOCATION......_�. L ..._____�/({/{J/H(��✓`j- '� ------- •____•__ ----------------------j_______•_____-_••_______••____ , � L �z - z !� ----------- Owner's Name----------------------------------------- -• Z-cr-------- --------- --------------. Phone-- -------------- - Address----------------------------------------------- r------. �� -f ------------------------ --------------------------------------------- Contractor's Name.............................. ------- ------------------------------------------------ Phone.i.—Av4_t_A.g'.7---- Installation will serve: Residence e' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number Number of bedrooms __ ''Number of baths ----1_ Lot size ------ �----------------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table //-�? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla ❑ A be[Hardpan ❑ Previous Application Made: Yes ❑ No [;;`flew Construction: Yes ❑ No ❑ /t-�e�--��- ° - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S �c T"a j Distance from nearest well-----------------Distance from foundation-------------------Material------------------------........_--------------- --- _._-__.--____. _..- Capacity----------------------- No. of compartments--------------------------Size--------------------------....Liquid depth osal Fjolld. Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- of lines-----------------------------------Length of each line------------------------------Width of trench-----------------------.----------- Type of filter material_________________________Depth of filter material-----------------------Total length......................... �� , Seepage Pit.: Distance to nearer well_ _._�_ __________Distanc�f� rq� foyndation____-__.___.__._.�Distance to nearest lot line_____/f�___._ Number of pits.... .................Lining material_____.____.___.___S__.Size: Diameter._ __3_<<_._.._.Depth.... -,1_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_______--_-__-__-__.__--_-_-_______-. \ ❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity..--------------------------gals. Privy: Distance from nearest well----------_--------------------------------------Distance from nearest building_:--__--__-____--_---_-------_.-__.- ❑ Distance to nearest lot line--------- ------------------------------------ ----------------••---•------------------------------------------------------------------------- Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------•-----------------------•-•-----•---•------------••-•---------- �\ --------------•----------•--------------------------------•---------•-------------.•---------------------------------------•----•------------------------------------------------------------------------------------------- I hereby certifytfhet ve prepared this pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r es and egulatio of the San oaquin Local Health District. (Signed)--------------------- ------ �-------------- -------------- ---_ -. r Contractor) Title xv-- BY: `` -�- (rifle) =•" --- ------ (Plot plan, showing size of lot, location of system in re' on to wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE.---- �--------------------------------------------- REVIEWEDBY------------------------------- ------ ---------------------------------------...------------------------ DATE.... BUILDINGPERMIT 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 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100