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r APPLICATION FOR SANITATION PERMIT , Permit No. ___3. �f_ •- �c� --� (Complete in Duplicate) f Date Issued 1 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 No. 549. JOB ADDRESS AND LOCATION----------J-5-0-7--•------ma c'` e----�-----"-" --�--- --------------------------------------------------------------------�. + 4 Owner's Name----------------------------- ' --------------------------• ------------- ----- Phone '��= ------- -_------- Address---------------------------------------------------- ar: -- ------------------------------------------------------'--------------------------------------------------------------------- Contractor's Name--------------------------- J�___ `rte`; = Phone = - ' , Installation will serve: Residence j2;_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---hf I Number of bedrooms __y Number of baths ---/--- Lot size ___ _ __'_ ._ "'__-------------_______________ ` Water Supply: Public system Community system C] Private ❑ Depth to Water Table _ f#. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: Yes ❑ No ❑, [ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: 01 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ae ptic_.an Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------__-_____-------_--___._-. fie- = No. of compartments------------ -------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well _ )t t _.Distance from foundation----- -----.-Distance to nearest lot line_ ' Number of lines_-..----.___ Length of each line________- --_----------Width of trench_____yf--____________- Type of filter material----1!---2-_fr��-Dopth,of filter material.-_--1_.. ........Total length-----/_ __________ Seepage Pit: Distance to nearest well"-f'l -c '____Distance from foundation----S0__r-----Distance to nearest "" ` r� Number of pits_______ ____________Lining material_ -A44'___Size: Diameter______3__:?"__Depth____ __�__---:_--___-. v` Cesspool: Distance from nearest wefl-----------------Distance from foundation--------------------Lining material_____________,__________________._.... ._Size: Diameter____________________ -----------,_De th-___------ - -- Liquid Ca - als. acIty, Privy: Distance from nearest well_________________________________________________Distance from nearest building__.._-__-_.________________________.___... ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- { Remodelingand/or repairing (describe):------------------------------------------------=------------------------------------------------------------------------------------------------------ I --------------------------------------------------•-----------------------•-------------------------------------------------- Y. _________________________________"______-____.....________-_-___________-___________-________________-_..________•_'.______________..___-_...___.___________-_--____-________ 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 SanJoaquinLocal Health District. (Signed)----- ' � :,r2:t�'___ �'7 ��` _r ��--------- -------------------(Owner and/or Contractor) By•--- - ----------------(Title) ` " " ! t�tT` �' , �i'--------------- (Plot plan, show' g size of lot, locatiok of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - �------ ---- -----------------------Vat- --------------------- ------------------ DATE---- --41 --------------- ---- REVIEWEDBY---------------------------------- - - -------=---------------- ---------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------- ----------------------------------- Alterations and/or recommendations:------------------------------------------------------ ------------------------------------------------------------------------------------------------------- -------------------------------------------- - -=------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------------------------- ` ---------------------------------------------------------'---------------------------------------------------- ------------------------------------------------------------------------------------------------------------- Date--- I-----rc ----------------- FINAL INSPECTION BY:--------- ' � ---- 1 > 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amo-rican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2l O0