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f •� � APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) aI �. Date Issued --- Application _Application is U®ribby made 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 LOC AT N_..-_------, -___- .•c'.1/ 'II __ Owner's Name------------- --- - ----- --- one ------ ---- - ----------- ------- -- ------------- -- Address-----------•------- `'d Al ----- --------- Contractor's Name-------- 10--------- "----�1�--- ----'�- ----- --------------�±-----•► ---- Phone__�� _____�___ ._._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___�___ tuber of bedrooms 4__- Number of baths _�____ Lot size -----------eQ Q�` �� --- --- -- --- -------------------- Water Supply: Public system Community system '❑ Private ❑ Depth to Wafer Table e ft. Character of soil to a depth of 3 feet: Sand ❑lllllllllravel ❑ Sandy Loam_ -lay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made. Yes ❑ No Ej0000PNew Construction: Yes EA0< ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: t Disfance from nearest well-----------------Distance from foundation-------------------. Material__________________.__._________________________. o. of compartments---- ------',--``- ��--,S�e Liquid depth--------------------------Capacity------------------- Disposa! Field: Distance from nearest well _hL� Wistance from foundati A«r __________Distance to nearest lot line___"_____________ �� Number oflines Len _ g}h of each line__ 7 .}74___Width of trench________ Type of filter material-I" __ ��_____TotaI length_______"Q__j__"----__-_ YP Depth of filter material___-�.____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________________-___________________ Size: Diameter--------------------------------------Depth-------- ------------ -------- ---------------Liquid Capacity- ---------------- --- gals. [� Privy: Distance from nearest well ___________________________------------------___Distance from nearest building____________________________ Distance to nearest lot line____________________________000 ------------------- -- Remodeling and/or repairing (describe}:_ ------------------- _-_--------- --------------------------------------- ______00 -------------- ------------ --------------------------------------•----------------------------------------------------------------------------------------------------------•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ -K["4--- --- --- ---- ------- ----- ---'---- --- ctor]weer /or Cont gY� �� ---------------------------------- ---- (Title) (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -- --B--Y-------------------------- ------------"------------------------------------------------------------- DATE ----------- ---- ----------------------------- BUILDING --------------------- BUILDING PERMIT ISSUED - - ------------- - ------------------------------------------------------ DATE- - ------------------------- ---- --- --- ------ --------------------------------- ---------------------------------- DATE-------- -- Alterations and/or recommendations:__-".----------------------------------------------- ---•---- -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- --�--,:f-_-"f�'`s-w--`------------- Date - " .s a r FINAL INSPECTION BY:__ 4 _� r ------- -----------/------------------ -------------------------------------------- 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