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`APPLICATION FOR SANITATION PERMIT Permit No. ! f yin Duplicate) 6 } (Comp e e G ^ '(A Date Issued ____ a'!- _pplttation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with C,ou tx0 mance No. 549. JOB ADDRESS AND LOCATION----- I------- --- ------ ----------0-F-------� r � ��"�' �---------------------- Owner's,Name-------•-------••-------------- - 1 r ------ -------------- Phone--:----------------------------•-- - ----- -------- Address-------------------------------------------------------------------�� .1.r2----------- �------ --- '---"f-----------------------•-----•------•--------•------•-•-------------------------_--L Contractor's Name—------------ --•-----------------------------------------------------•----------••-------------------•--- Phone--------•--------------------------:: "n Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/-- Number of bedrooms,3_._ Number of baths _I--- Lot size _________ ---K-_�L-47_P___________ 1 Water Supply: Public system " Private ❑ Depth to Water Table -------- ft. ; Character of soil to a depth of 3 feet:"`Sand E] Gravel ElSandy Loam E] Clay Loam E] Clay [:] Adobe [ a-Hm*an E] Previous Application Made: Yes ❑ No ew Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest well___'"'~~..__Distance from fourkion. /J � --Material---- -m--- No. of compartments__.__..__..~=Size......� y q- ep-- _--Capacify_ Fr -. 1-__-.__ W-I N. Disposal Field: Distance from nearest well_.~" ._.Distance from foundation___ to nearest lot line_ -._- + ] Number o1 lines-------------t-..--..------------Length of each line----- •t3r_ r' "`V�lidth of french_.___._. ___.____ T e of filter materiaLr__ ___De Total length____ Depth of filter material___.__ _ '___ __.______ french- Type p f Seepage Pit: Distance to nearest well----------------------Distance from foundation.........----------Distance to nearest lot line_____.__-.__.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----.------------------Depth..------------------------------- Cesspool: Distance from nearest well----------------Distance.from foundation--------------------Lining material ,. _ - ._ __ `---------- L] --❑ � .=- Size: Diameter--'-.---;_ ----------------- Depths ----------------------------------Liquid Capacity----------------------------gals . Privy: `, Distance from.nearest well------------------------- -------------- ------Distance from nearest building-----------------_-----------------------. ❑ Distance to nearest lot I;ne----------------------------- Remodeling and/or repairing (descril�): --~--------------------------------------------------------------------------------•-----------•-------------------------------•-----------•-- ---•- - ------------------------•----------------------------•--•-------------------. ------•--------•-- ----------------------------------------•--------------•----•-------------------------------------------------- ----------------w----------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------•-------------------------_--•--------•--•--•---------------------•---------------------------------------------------------•------------------------- ------ I hereby certify tha I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances C.L.4e laws, es an re ulati o the San Joaquin uin Local Health District. 9 q t (Signed. ......... ------------------------------------- -'=---------:-'--------------------------------------------------(Owner and/or Contractor) By:-----------------=--------------------------------------------------------------------------------;-- ------------------------------(Title)-------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION..ACCEPTED BY ---------------------- -= DATE--------�- - r� REVIEWED BY--------------------------------- - --------------------=f--------------------- DATE----------------------------------------- = BUILDING PERMIT ISSUED--------------•---------- --------------------- ----- - ` .._..-- ------------- DATE--------------- - --------A-----------^- Alterati ns nd/or recommendations;-, Q__�2�-$.�____.._ ____ i7.�r4eC-- GG�4��_____ __ _ .� _. ---- '� fir - E ------ ---- �J - •-• ----• -•---- ---- a {�►.e! } ?. Date - - ------------------------------------------- FINAL INSPECTION BY------------- 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 Fir