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_! 1n, JJJJJJi7� APPLICATION FOR SANITATION PERMIT Permit-No '�_/-___ ___ (Complete in Duplicate) Date Issued__a_�fS Application is hereby made to +he San Joaquin Local Health Distric+for a permit to construct and install the work herein described. This application is made in compliance with County Or inance No. 549. JOB ADDRESS AND LOCATION---------�` r - -� Owner's Name ------------------ Phone ---- Address------------------------------------ -�---- ------ Contractor's Name------------------- --�-----�� d=-----------�-►---- -----------------. Phone-----Z!---------------__- Installation will-serve: Residence ❑ Apartment House Commercial ❑ TrailgoCouurt ❑ Motel ❑ Other ❑ Number of living units:/4___ Number of bedrooms /J__ Number of ba+hs'T »---------------------00 �,,,. �..of size ---- ` ---��-+------------------------- Water Supply: Public system ❑ Community system '❑ Private ❑ Depth to WaferTable4&4 Waterff.+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: Yes ❑ No;Y- New Construction: Yes ❑ No ❑a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic-T-nk; e-DiOan-ce'frorrf-nearesf-well----- Distance from,foundation-.-------------------Material--------------------------------- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- D' I Fied: Distance from nearest well-----------------Distance from foundation_____________-_____-Distance to nearest lot line________.___-__- 7 Number of lines------- -------------------Length of ch--line--.-------------------------Width of trench-----------------------------------� Ns `v Type of filter material--------------------- e o filter maters - -------------____---Total length-----------•-_---------------------------- Seepage Pit: Distance to nearest well �"..'t4�___D ` Di ante un ati n_ __ ____________Dis ante to nearest to line_ p______. Number of pits________________Lining ma erial Siz : iameter---__� �__.Depth___�-y- _ Cesspool: Distance from nearest well_________________ istance from foundat' n-------------------- material-----------1 __-.__-________. ❑ Size: Diameter-------------------------------------- Pth--------------- ------ ---------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well_________________________ ___________ _______Distance from nearest building------------------------------------------ El Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodiling and/or repairing (describe)=--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------.---------------_--------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this ap lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, *sandulation f the 5a Joaquin Local Health District. (Signed)---- -� --- �-- Oi Qe--- - ---- �------------------*----------=~-----o---------�' (�1� r Contractor) -------- ---------------------------------------------------------------------(Title)-_ ��---'------------------- (Plot plan, ize system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - DATE-1'_____--------------------------------------------- REVIEWEDBY---------------------------- ------------------------------------------------------------------------ DATE '` BUILDING PERMIT ISSUED--------------��'----- -- DATE.------------- Alterations ----__ -Alterations and/or recommendationsF - ------------------- ---------------- ----------- ------------ --------------------------------•------- ---------- ----- -- --------- --------------------------'f- ----- ---------- - - ---------- 1�4 ------ -- - ------ --------------------------- -----------------------• ------------------------------ ------------------------------------------------------------------------------------------------------------------------- -------•------------------------------------------------------ ------- -- ---------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY----------------- - -------------- 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 8-51 Revised W-2100