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APPLICATION FOR SANITATION PERMIT Permit No. ....Ia._v (Complete in Duplicate) Z .2� Date Issued .___.____ ____ .pa ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Ths application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- Owner's Name-------------------------------------------------- �`�� n �`� Phone � Address.................................................... Z--(=N_rxx-Q------ (� -------------------------- Contractor's Name----------------------_---- - 1 r 1 1 C-----&-c— . PAne------ ��j�•---- Installation will serve: Residence 21 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___l___ Number of bedrooms ___I-_ Number of baths .__/.. Lot size -----_670__^_K_.i..tx.Q_-______________________ Water Supply: Public system g Community system ❑ Private ❑ Depth to Water Table .... ft. Character of soil to a depth of,,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g Hardpan ❑ Previous Application Made: Yes ❑ No`j!�-- New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S f Tank: Distance from nearest w II_nO(f_E---Distance from foundation..1_5.__e-____.Material-----h_�-�!_:3'L�=_ __ _- No. of compartments__--- -------•-------_-Size__.�7 3� __ _ Liquid depth---- ---------Capacity bbb Disposal Field: Distance from nearest well-47-Ma---Distance from foun ation__I_ --________-Distance to nearest lot line----- Number of lines-----------------------------------Length of each line__.eQ'e---------------Width of french----Z_4..If � F Type of filter material____�j _ ____________Depth of filter material-----1__f ........Total length...Z.0---__._--._---_____-___--____ Seepage Pit: Distance to nearest well__1 4_D_P0Z-_---Distance��,f,qrrom�� foundation,.'_........Distance to nearest I t line----� Number of pits-----I----------------Lining material.It---- �cslS�-----Size: Diameter__-J-3ir-----.Depth---� -------..--------- 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------------------------------------ --------- ---------------------•- Remodeling and/or repairing (describe):----------------------------------------------------------------••--------•----- -----------------------------------------------------------------•---- ----------------------------••-------------------------.-------_----------------------------------------------------------.----•------------------------------------------------------------_----.----.----------•----------- I hereby c ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St t laws, and rules and regulations of the San Joaquin Local Health District. j (Signed)-------- &'v4+'h -'--- ( Contractor) By:................................................ ---------- l (rifle) - -- ---- - --- -- ----------- (Plot plan, showing size of lot, location of sys in relation to wel , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- --- -------------------------------.- DATE----------- REVIEWED BY ------------------------ ------------------------------------------ vse-------------------------------- DATE--------- ----- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----•------------------------------------------------ Alterationsand/or recommendations---------------------------------------------- - ------------------------------------------------------•----------------•---- --------------. ................. -------------------------------------------------------------•---------------- --------------------------------------------------------------------------------- ---- ----------------------------------------------------- ---•••---------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------.---.-•................ ---------------------•------------------------------------------------------------------------------------------------------ -------------------------------------- ------------------------------------------------------- FINAL INSPECTION BY-------------- --=... ---------- Date-------- e� t� � ------------------------------------------- SAN ------------------------------- ---------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 10-52 Revised W-2100