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APPLICATION FOR SANITATION PERMIT Permit No. _ ."-- (Complete in Duplicate) Date Issued _/ s Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wort: herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION ! '- l - ` E-0--------- -'-------- 'r_ _ _ " +t ----------------------------------------- Owner's Name N-11-S-1. _ liv-- ' Phone Address----------------------------------•------------------- �-D- 77 ------------------------- ----------------- Contractor's Name----------------------- [- - "Y _4_ _�- -______: ' '''° •— - - --------- -- ------ Installation will serve: Residence Ik• Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I_--- Number of bedrooms ___L Number of baths __f___ Lot size ----- �-1-----------___- Water Supply: Public system 5( Community system J-1Private ❑ Depth to Water Table �47 ft. `" Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [e Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feel f, �r �� `tea,�.,c,r! Septic Tank: Distance from nearest ►lh�t.C �___-Distance from fou`. ajjon_) ___________.Material`_"�_________ __________ �-- No. of compartments--_ ____Size�°�_ __ _ _ 'Liquid depth__�_2_ _________Capacity"" ___l ;C.S Disposal Field: Distance from nearest well Distance from foundation,___ --- L________Distance to nearest lot line--- Number of lines---------I----_ Length of each line-_ �_ _ Width of trench__ _ ` !�r i L /! Type cf filter mate nal__1612__ lS,____Depth of filter material__.__�_� ________Total length__- '�_______________________ Seepage Pit: Distance to nearest well-____________________Distance from foundation-------------------.Distance to nearest lot line_______________ t ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.----------------------Depth---------------------------- Cesspool: Distance from nearest well--------_--------Distance from foundation--------------------Lining material___________________----____.________. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals I Privy: Distance from nearest well______________________________________._________Distance from nearest building---------------------------------------__. ❑ Distance to nearest lot line-------------------------------r------------------------------------------------------------------------------------------------------------- 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, an rules and regulations of the San Joaquin Local Health District. ,4 #. t_ -. 4- (Signed) --� ri=" ------ I�. . ------- e-----�r. Contractor) jsh� ng By:-- ---- ------------------------------------------------(Title)----- C flG�-1 ---------------------- (Plot plan, size of lot, location of syr sf�m in elation to wells, buildings, etc., can be placed on reverse side). ��,,,, FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--Q ------------------------------------------------------------------------------------------ DATE__r '----------- ------------------------------------- REVIEWED - - REVIEWEDBY------------------------------------e --- ------------------------------------------------------------ ----------------- DATE------ � � BUILDINGPERMIT ISSUED---------------- ----------------------------------------:------------- ------ DATE------------- Alterations and/or recommendations:---------------------------------------------- ----------------------------•-----------------------•---- ----------------------------- ---------------------------------------------•---------------•---------------------------------- ------ --------•--- -----•------------------------------------------- - ---•---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ' + 1 FINAL INSPECTION BY:------- - ------- -------------- Date--------7 ___X_?.' _ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 -Revised W-2100 . r4 a