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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ti TA�plicafiion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 5,49. '�y JOB ADDRESS AND LOCATION------!o-2-6VA- 7---------- -- -- -- - -------- ------ "-----------------------=------------------------------------- n • Owner's Name----------W-11111AM. .........7------- ------------------------------------------ ---------------------------------- Phonej----*--;74-7--------- '-7A. D------------1--P25 ------ t#4 __VAddress--------------(-4- .;e -----------49X ----------------------------------------------- r7Contractor's ------±g?------- ��Owi5sL... Phone--------- ------------ Installation will serve. Residence Apartment House F1 Commercial El Trailer Court El Motel 0 Other D Number of living units: Number of bedrooms - - Number of baths I 1:5---- Lot size --- 4 Ow ZL ejs(--- -----------7---------- Water Supply: Public system � Community system -E] Private E]- Depth to Wafer Tabla-,5-ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam F1 Clay E] Adobe M Hardpan S, Previous Application Made: Yes E] NoNew Construction, Yes F-l No Dr K 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-----------------Distance from foundation--------------------Material------------- ------------------------------------ ElNo. of comparfmenfs--------------------------Size--------------------------------Liquid depth--------------------------Capacity------------------ Disposal Field: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line-"--�----------- El Number of lines-----------------------------------Length of each line------------------------------Width of trench-----_----------- --------- Type of filter material-------------------------Depth of filter maferiai-----------------------Total length________________________________________- Seepage Pit; Distance to nearest well-IYOA1Z-----Distance;-Fom foundeflon-'6V........Distance to ne6.rest.JdHine-- Number of pifs-e'77)-'L,9 Liningze: Di`ameteL-,,,,— material-._40 !AX/Si ------Depth(, ----------------- Cesspool: Distance from nearest well_________________Distance from foundation----- ------------- Lining maferial--------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 171 Distance to nearest lot line------------------------------------------------------------------------------------ ----- -------------- ---------- Remodeling :)e)------I- ------ _--c --------- 6 and/or repairing (clescril --------------- - --------------------------------- �X; A --�U--t - -W-------------i---- --j--------4--------------------------------------------------- ------------------------------V-----------I------ ---------------------------- ----------V-------------- V ------------------- -- ------------------------------------------------------------------------------------ I --------11------- --------•-------------- -------------------------------------------- -----------------------------------------------------------------................... ..................................... ------------------------- -- -----------------------------------------------*-------------------------- I hereby certify that I have prepared this application and,thaf the work Nle, done in accordance with San Joaquin County ordinances, State IS and ru arl 43 sand ref la ons of the Sa oaquiAocal H th District ----- -------- -----I----- ----��J- Owner end/ Cont Factor)(Signed)------------------ - ----- --------- ------ ------ By:---------------------- --------------- o"" .....Z_j --------------- ------ --- -- ------ -- -----------------(Tif le)------ ---------------- (Plot plan, showing sizeo lot, location of system in relation0 wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -'-- ---------------------------------------- DATE ;;!�;---------------------------------------------------- ----------------------------------------- REVIEWEDBY----------------------------------------------------------------- -------------------- --------------------------------------- DATE---- BUILDING PERMIT ISSUED----------- ------------------------------ DATE------- ------------------------------ ----------------------------------------------- ---------- Alterations and/or recommenclaf ions: ---;----------------------------------------------------------- --------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------! -- ------------------------------------------------------------------------------------------------------------------I------------------------------------------ ---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ------------------------ ------------------------------ -------------------------------------I---------------------------------------- FINAL INSPECTION BY:------------- - Date -02 --------------------I------- ------------------------------------------- ---------------------------- 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