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APPLICATION FOR SANITATION PERMIT Permit No. �-__/_..-. (Complete in Duplicate) / Date Issued 4 it / --LD � -_-.--� Application is 2here6made 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. JOB ADDRESS AND LOCATION•--_--SO S. C1/I,-0--------------------- Owner's Name----- '' " -r L�� Phone y- 7 -------------------------- -------- *-�b�'-"----------- -------------------------------- Contractor's Name------�?4--------Y ----------------------------- ------------------------------•--•----- Phone.7_-Q.f�•Z Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f-__ Number of bedrooms -_ _- Number of baths ./-_ Lot size -----------------.-_-.-_ Water Supply: Public system V Community system ❑ Private ❑ Depth to Water Table -yA_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,M Hardpan ❑ Previous Application Made: Yes ❑ No 19 New Construction: Yes ❑ No/K TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pli Tank: Distance from nearest well-----------------Distance from foundation------------.------Material_-----.---_-.-..--._--_-------------..---.------. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------------- isp ai Field: Distance from nearest well-----------------Distance from foundation------------- .__---Distance to nearest lot line-.-__-._---_----. a Number of knes-----------------------------------Length of each line-------------_-------.--------Width offrench.------.--------------------------. Type of filter material---------------_---------Depth of filter material------------------ length---------------.----------------------._-. Seepage Pit: Distance to nearest weIIA_W- ----Distance from foundation---7_-d-..-._-- Distance to nearest lot line----------------- l,� Number of pits.-_._/-------------Lining material-4Z- _�__ ._!__.Size: Diameter----3`�r------------Depth !�5..-------._---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia)._.-----------------.------.__.__.__- ❑ Size: Diameter--------------------------------------Depth--------------------------------- --------- - -----Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------_-----_---------Distance from nearest building----------------------------------_--..- ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------------------------------------------------- ---- Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------•--------------------------------••------•--------------•------------------------------------------•------...-------------•-------------------------------------------------------------------------------- --------------------------•------------------------------------------------------------------------------------------------------•-•---------.-...----.------•--------------------------------------------------------------- ---------------------------------------------- --------------•---------•---------------------•-------------------------------------------------••--- -------------------------------.----•.---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-. -- -----------------------------� ` '�`°`�--.`-..--.`�!------------- �wneror Contractor) --- By:-------��.r --- ------------------------------------------------•-----------------(Title)-- 'ir.r ----------- (Plot plan, showing size of lot, locati�?of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------------------------------�/� DATE---------- ----------=�- REVIEWED BY--------------------------------------------------------------------------------f',---------------------------------------- DATE---------- -- -- ----- ------------------------- ----- BUILDINGPERMIT ISSUED------- --------------•- ----------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------- - .... ' - -------------------------------•----------------- /�. ----------- -� ----- ----= . ------------------ •--------------•- ---------- -------------------•------•------------------------------------------------ _------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ------•---- -------------------- -------------------------------------------------------------------------------------------•------------------------------------------- ------------------------------------------------------------ - ------ ------------------------------ ----��--„-//---��------------------ ---------- --------- -- '^J 0 FINAL INSPECTION BY----- ---------k...) t ` -------I 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 10-52 Revised W-2100