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q ,Q 5 /APPLICATION FOR SANITATION PERMIT "Permitr' o. __ - _ `��----- 1 {Complete in Duplicate) D n� fi ate Issued l�A(klication is hereby made"to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. PP This application is made,in compliancewtrLC unty Ordinance No. 549. �------------------------------------------------------------------------------ JOB ADDRESS AND .^ -----------------�- "� � ZJ-c -------- Owner's Name----- ----------- ------ -------------------------- -- ----- Phone------------•- �'--------------- 1 �. 4 a ____-------------------_ ___________------- Address---------- ______Address---------- I�' � ------------------------------------ ----------------------------------- , a-y�� Phone. !f�f P Gontractor�- Name------------•-------------- --'--- -�--------- --•--------- ------- ----�------ Installation will serve: Residence* Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other []ems r ---_ __ 0--�---�•--�-�--� Number of living units: -1----- Number of bedrooms __-$- Number of baths -- __� Lot size -------------- Water Supply: Public system$ Community system -El Private C1 Depth to Water Table _ 0 ft. Character of soil to a depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,4 Hardpan ❑ Previous Application Made: Yes [) No ,[. New Construction: Yes ❑ No ❑ �,_,V' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__-6�------Distance from fo nd io _____ t Material .'�' - No. of compartments---------- Size --- - ------------- uid depth---C .`�______--____Capauty_ , Z j•' s. Disposal Field: Distance from nearest weal- .0----- Distance from oundation__p �______Widt co to nearest lot line------- ------ I 1 __Length of each line_____��-r-----==----Width of trench__�`�`�'------------------- f Number of lines------ --------------=;---,y--- r/ �. Total 'length s __® Type of filter material Depth of filter maternal____: _ -- ----•-- f n 20'-___-.p stance to neares# lot line___ d Seepage Pit- Distance to nearest well_--1'-QRJ_ ___--Distance from foundation_____._._ {'. Number of pits.____________ ---Lining material 1 ____Size: Diameter___�,3-'`_........Depth__-*;�V---------------------- 6' yl� Cesspool: Distance from nearest well-----------------Distance from foundation_______--___-_____-Lining material_________--_____--------------als. ❑ Liquid Capacity Diameter---=---------- ----------- ----------Depth----------------------------------------------------- - _g,. . . . Privy: 'Distance-from nearest well-------------------------------------------------Distance from nearest building------------------------------------ /n ° ❑ Distance to nearest lot line------------------------------------------------ -------------•--------•---------- ---------- ---------- V► I . .. Remodeling:and/or repairing (describe)______________________________ -------------------------------------------------------------------------------------------------------------------------•------------ --------------------------------------------------------------- �---- ----------------------------------------------------------•-------------•----------------------------------------------------------•-------------.. ... ------------------------------------ --------- ------ ------=--------------------------------------------------------------------------------------•---=--------------------=------•---------------------------------------- �. hereby.certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun y ordinances, State laws, and ru s and regulations of the San Joaquin Local Health District. �' I f� f ( -s.. Contractor) ---------------------------------- (Signed)- ------------------------ -- --- --- - - ---------- j _ - - -�� - - - ------------------------------------------------------ ------------------- [Ts#I By:--- y (Plot plan, ing size of'lot,'I,,af�on f s stem in relation to wells, buildings, etc., can be placed on reverse side). P FOR DEPA TMENT SE Y r` APPLICATION ACCEPTED-BY--------------------- - --------------------------------- --- DATE- -- ----- ----=- ------ - -- REVIEWED BY ---------------------- ----------- ------- DATE - - -=- --- BUILDINGPERMIT ISSUED------------------------------ - - --- ------------ DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------- --------------------------------- -- ----------------------------------------------------------------- --------------- ---_- --- ---------- ----j--- ---------------------------------- ----------------------------------- ---------------------- --------------- -------------------- __ - ------- ----------.-:-----------'--`----- ------ ------------ ------ ----------------------- FINAL INSPECTION BY:-------- _Lf. . ----------------------- Date - ------• -- 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 B-51 Revised W-2100