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y L APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) _ Date Issue ___ -- i 7 .. f App litation is ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This appkicati n is made in compliance with County Ordinance No. 549. JOS ADDRESS AND LOCATION-------------0 -4---------` ----------------------------- r -------------- --- Owner's :.------------------- ' ---------- Phone---Z_-_73--24 �--_-_7�- 2 OwnersName-----------------------•-V--'-�-�----------�---- - -- -- -- -----------------=- - - --------- Address----------- - --------- � ----------------•---------------- ---------------•_------------------------------------•-•--------------------------------------- Contractor's Name----------------------- - --n-- - -Y----�_ _._ - ------- ----------------------------------- Phone---------------------------------- Installation will serve: Residence E] Apartment House,0 Commercial 1❑ Trailer Court ❑ Motel ❑ Other [ � f E Number of living units: le__ Number of bedrooms!------- Number of"baths -------- Lot size _____________�_ _____________-____-_ Water Supply: Public system UK—community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel i❑`Sandy Loam ❑ Clay Loam Clay ❑ Adobe 52—Hardpan ❑ Previous Application Pude: Yes �o 0 New Construction: Yes ❑ No 2. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is availa6le w4hin 200 feet.) Septic Tank: Distance from nearest well___.___Dis+ante from foundation___. a__ Mate_r�aL�r__------------------------------------------- N6. _________________ _ iJa. of compartments- 'Z"� Sixe 3 fC .�- -1�U Liquid depth 5 Capacity ODD Disposal Field: Distance from nearest well...._________.._.Distance from founda+ion_________-_______.Distance to nearest lot line________________ `7 fj❑ Number of lines-------------------------- --------Lengfh of each line---------------------------.-.Width of french--------------------------------- or e - Depth of filter material------------------ Total length-----------._---------------•------------- T e or filter material__________�.�___-_ - p Seepage Pit: Distance to nearest well----------- -Distance from fo Number Distance to nearest lot line--------__._____. ❑ Number of pits----------------------Linings-rateTial----------------- ---.Size: Diameter-----------------------Dept h--------------------------------- ra Cesspool: Distance from nearest well-------------!-.-Distance from foundation--------------------Lining material---------_----__________-___.______. ❑ Size: Diameter------------------ -___Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: -Distance from nearest v 4_7_�------------------------------------Distance from nearest building------------------------------------------. ❑ Distance to nearest lot line----------'-------------------------------`------------------------•---- ------------------------•------------------- ------------------ Remodeling and/or repairin (describe --------------- !----------------- -•----- ----------------------- - d` .""'""-------- f _ __ ----------- ' ------- --•-----� J---- - ------------------------- --------- ------------ ----------------------- ------------------- 1 hereby ter--- that I have repared this application and that the work will done in accordance with San Joaquin County Y , Y ordinances, State laws, and rules and regulations of 'the San Joaquin Local Health District. Si ned A,,� ------------------------------ ------------------------------------------------(Owner and/or Contractor) 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 --------------- - - REVIEWED BY l - - - - DATE -------------------------- � _ � . BUILDINGPERMIT ISSUED-------------------------------------------------------------- --------------------------------------- DATE---------------�------------------------------ -------------- Alterations and/or recommen ations:..-___ `�1 "�" �-----------••------------------------------------------------------------------------------ ----------------- F ---- ------------ ---------- ----- - ------ Z--------------_4/ ------ .---------------------------------------------------------------------- - • _ � f� �t r ---------------------------------------------------------------- ------------------------------ -------------------------------------------------- - ---------------:------------------ ---------- ------ Date-. -�� -------------------------------- d___1 �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 1 ES-9-2M 10-52 Revised W-2100 ty