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APPLICATION FOR .SANITATION PERMIT Permit No.,6'.Z/�...lt�. ` \ A (Complete-a� Dyplicate) /'�`(/� D to Issued _. ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and i i the work herein described. This application is made in compliance with County Ordinance No. 549. a. " JOB ADDRESS AND L CATION.-.-•�_y '____-__ S _ `l I�1 � �_ fa__.. 1 Iv �1T.:__.l_4---- Owner's Name-_ ------ _ Phone-_ Address--------�1.e ----- , --- -------------•-•-------------------------------------------------------------_--------_--------------------------------------------------- Contractor's Name - Phone ------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t Number of bedrooms j__- Number of baths/...... Lot size _,7 .1 p............................... Water Supply: Public-system ❑' °C61 munity system ❑"-Private I .Depth'to Water Table !lO-___ ft. Character of soil to a depth of 3 feet: Sand 3 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No IN New Construction: Yes % No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s2ww is available within 200 feet.) Septic Tank: Distance from nearest wQell_31,9_e_,Distance froggy�/ �foundation__/AMaterial/_ - ne� V3No. of compartments-__- -----------------S ize.�.,�.,5__!_t_I.......Liquid Capacity _ Disposal Field: Distance from nearest well - _ istance from foundation___ rDistance to nearest lit Number of lines__. ->--_-_ ._.____-____Length of each I Width of trench_ - -------- , Type of filter•material--- AAAR---Depth of filter material_fi- ./��._Total length...Jf. Q� --------- Seepage Pit: Di;tante to nearest well_ __________Distance from foundation----------- .Distance to nearest lot line .......... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------- ,,----.-.__------ Cesspool• Distance fi•om nearest well---------_-----Distance from foundation--------------------Lining material------------------------------------- El ______________ _-_-____-❑ Size: Diameter--------------------------------------Depth------- _ --------------- ---------------------Liquid Capacity ------- -----------gals. G Privy:- Distance from nearest well :-- Qistance fr9m wrest building i ❑ Distsrit "Foil a e"si' to in --------------- - -------------------------------------------- ---------•-• ----- ------•-- •----- --- ----- Remodeling and/or repairing (describe) _____-__ 11Z W4....._.�� _� �� ,�& ______ ____________________ _ -----•-----------------------------•-•- ..........................., ; .�. ----------- ----- ---------------•----------•----------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- G' L► 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws and rules and regulations of the San Joaquin Local Health District. (Signed e ► , ------------------------------------------------------------- and/or Contractor By:--------- ----' -----------(riifle)--- -- ---- - --------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on reverse side). R D ARTM T USE ONLY APPLICATION ACCEPTED BY----- -- - -- - ---- - --- ---- ---- - ----- ------ --------------------- DATE-----7- J- *9- , `----------------------- REVIEWED -------------- REVIEWEDBY-------------------------------- ------------------------------------------------------------------------------------------- DATE__.------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendation - ------------ . -- . ----------------------------------.................. --- --- - ------ --- -'--- --• ------- - -----••-- ----- --- ---- --- ------ -------- ---- ------------..•----•------------------------------------------- ------------------------------------------------------ .....--_ ......... ----•------------------------------------------------------------------ - --- ----- ........................... FINAL INSPECTION BY: -- ...... ---- J- - �..0�iht -- ` :1r Q ., 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 Io-.52 Revised W-2100