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APPLICATION FOR SANITATION PERMIT Permit No. S__3__1..--`----- a`Y (Complete in Duplicate) �y Date Issued Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance with County O dinance No_ 549. ' r JOB ADDRESS A OCATION. - - ----------- Owner's Name Y; Phone_c�_"� --- Address----------0..l--P- 9-----F �-�� - --------------------------------------`-----...----------------------..-------------------------------------------.------- { ! r ------------- Phone---------------------------- Contractor's Name.{��:�------ ----------------��- ------- - --- �`(�+t ------------- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mof7l ❑ Other ❑ Number of giving units: ___� Number of bedrooms s3 Number of baths __�.__ Lot size _�-Il____x_��_U______-__________ ___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table __ya- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;;"No Clay Loam ❑ Clay ❑ Adobe a--/Hardpan ❑ Previous Application Made: Yes E] No V New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well_______________Distancebfrom foundation_____!__ -------.Matgr al_______ _____.___. ____ ,________-_ �,,, Li uid de th_______________ -- -- No. of compartments----------- - Size/0-�-X �_X _ .___Capacity Dispo �1 lel Distance from nearest we l ;�_.`_ Distance from foundation___ __ _ Distance to nearest lot lip-14)____ Number of lines___________ ____ __`f_____ _.Length of each line______'_S�K� --Width of trench________ ___________._.. epth of filter material_______ _ g Type of filter materia__ � ® __Total length _ Seepage Pit: Distance to nearest well___ ---------------Distance from foundation___ ___.______..Distan�e to nearest lot in + _ -___ Number of pits-----------.�_______Lining material._ ____.Size: Diameter----�;�_!________-.Depth___�-e ______________ Cesspool: Distance from nearest well---------------_-Distance from foundation--------------------Lining material------------------------------------- 0 Size: Diameter--•-----------------------------------Depth- -------------•-----------------------------------Liquid Capacity---------------------------gals. ° Privy: Distance from nearest well------------------------------------------------Distance from nearest building____________-__________________________ ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------•-------------------•-------------------- Remodeling and/or repairing (describe)-----------------------------------------------------•---------•--------•-------------------•-------------•-----------------------•----•--------.----- --------•-------------••-•--•----------•-•------------•-------------------.---•-•-------------------------------------•------------------•-----------------------------------•---------------•------------------------------ I ----------------------•--------------•----•------------------------------•----------------------•- ------ --------•----------------------------------------------------------I--------------------------- hereby certify that I have prepared this application a d lhiatl�e work will b done in accordance with San Joaquin County ordinances, States and--'rules and regulations of the Sa Joaquin Local Heal District. (Signed)- '� x= - ==-- {Owner and/or Contractor By----.......----------------------------• = ----------- -----------------------------(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-- ------------------------------------------------- REVIEWEDBY----------------------------- ---------- ------------- ----------- ---------------------------- DATE------- -------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------- ------------------------------------- DATE-------------- Alterations.�and/or recommendations- ..¢3 ------------------------ =------------ -------------•---------------- { 1A ,,,N_� ?, �__ _ ' �________ _P--C - _e__, __._____a._n_a ______________ - �. j-- r f i --------4. ------�----------- —f_'-------`------------��--•n----------A------------ ---- ---�V-__--------- ,i ' ----------- � ------------------------ -------------------------------------------------- ----------------- - s � FINAL INSPECTION BY: �S •-� ``,a��•'-- ------ ------ 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 8-51 Revised W-2100