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APPLICATION FOR SANITATION PERMIT Permit No. - .� (Complete in Duplicate) Date Issued ---------'ts��--�� 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. aJu _t- , ------ !_l--- -A -------•--•-=------------------------------------------------------------ JOS ADDRESS AND LOCATION________ __. _ Owner's Name--------------------------------------------(ALIYU ------ ---------!__` ----------- Phone---- r Address----------------------------------------------------------LL, -------S-1--------------------------------------------------------------- Contractor's Name----------------------------------10aM Phone Installation will serve: Residence tR Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms l______ Number of baths I-_____ Lot size _____ _-_____________ Water Supply: Public_ system ❑ Community system ❑ Private jo Depth to Water Tablet-la ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: Yes ❑! No jo': New Construction: Yes$a' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)11 11. f Septic Tank: Distance from nearest well--_4&.0*'__Distance from dation----f_Q_�____.Material------- ___ ____�s,____- ` ' No. of compartments____�v_._.____-__.__Size-. `.`_mac--_Liquid depth____ �arf____._Capacity___�_S��?.. RS F Disposal 3 i puss} Field: Distance from nearest weil___:�_Q'..._.Distance rum foundation_____ t? __.:.Distance to nearest lot lire_ ________ Number of lines____________________ ___ _ Length of each line----�_O .__________.Width of french- 191 _.Q.___________________ J-DType of filter material____j_��__ ____Depth of filter material______ _-._'_-_____._Total length_ _r_____________________________ w Seeps a Pit: Distance to nearest well---I._0Q.-._-_Distance from f undation__-.--f__0_}'__.Distance to nearest lot line____ .- a �-...Size: Dameter_ ___________Number of pits. ------------Lining material—& Cesspool: Distance from nearest well-----------------Distance from foundation_J`_�_.___.Lining material-----------------------------------__ ❑ Size: Diameter---------------------------------------Depth--;-------------------------------------------------Liquid Capacity_--------------- - -------gals. Privy: Distance from nearest well--------------------------------------------_------Distance from nearest building..________.__.______________--------___._ V ' ❑ Distance to nearest lot line---------------- -------------------------------------------------------------------------------------------=----------------------- ----- v tORemodeling and/or repairing (describe): ------------•-------------------------------- I ---------'------••----------------------------•----•---------••---------------------------------------------------------------------------------------------------------------------------------- ----- -- 1 ------------------•--------------------E=-----------•---- - ------------------------------------------------------•-------I-------------------------------------------------------------------- --- --------------------------------- -- i;. I ! hereby certify that i have prepared this appli-anon and that the work will'be done in accordance with San Joaquin County ordinances, State laws,?and rules and regulations of" he an Joaquin Local Health District. --------------- OV-0. E'd ,or Contractor Fr1% ( 9� I Si ned -. , ----- k r g 3 -. - -- 1"'�-^ ----- - (Title)-------� - Au ----------- Y:----------- (Plot plan, showing size of lot, location 4 system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE '>� --------------------------------- REVIEWED BY----- ---------------------- -------------------------------------------------------..--------------------- DATE o�p_ ------------------------------------------ BUILDING PERMIT ISSUED----•---- = DATE Alterationsand/or recommendations:---------------------- -------------------- -----------•----------------------------•-------------------•----•---.----•-----------•-------------------- -- I ---------------------------•--------- -------------•----------------------------- --------------------------------------------------•-----------------•---•------------------------------------------------ -------------- -----------------------------•----------...-----------------I------------------------------------------------:_1---------------------------------------------------------------------------------------------------------- it-------------------------------------------------- ------------------------ - -----• -----------------•------------------------- j ------------ ----------------------------------------------" FINAL INSPECTION BY:--- ------ Date......)_/ - .-.--- -----------2-----------------•----------------•---._-- �tiu I 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