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V u 5 APPLICATION FOR SANITATION PERMIT Permit No. ,}o� (Complete in Duplicate) t1 Date Issued ----� Application is hereby 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 LOCATI N---__ -----_ ------------- ____eef -- -- - aW.d° Owner's Name------------------- -`- -�------ ------ � - ------------------------------------------------------------ Phone-----------•----------- e AAdress_____________________j___ __ --- _ ----- ------- �- ( -� -- ---- ------------ -------------6 ------ Contractor's Name---------- # �" 2 '� (Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --[---- Number of bedrooms _ Number of baths _ __ Lot size __----- - __-- __L t---------------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table --- ft. Character of soil to a depth of f feet:- Saeid Gravel ❑ Sandy Loam ay'Loam E] Clay ❑ Adobe ardpan ElP Previous Application Made: Yes F1Na:- New Construction: Yes No El TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic an¢: F Distance from nearest well----------------- from foundation--------------------Material-------------------------------------------------- t No. of compaIfmeats--------------------------Size------------------------•-------Liquid depth--------------------------Capacity------------•---------- Disposal Field Distance from.nearest well________________.Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material----- --- ------ --- -F epth of filter material---__-_-----_- ---. Total length.-_-.--.......--...-..•..--_-_-..�.-- C ^� Seepage PitDistance to nearest well -------___- Distance f m fo Adation--,�-�-----__.l}is nee to nearest lo line--- L Number of pits-- r_- Lining materia!-� - p !Size: Diameter____ ________Depth----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----_-__--_--_-___--_-__------- I ❑ Size: Diameter----•---------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: -.r " Distance from neares#well--------------------.---____-__-- Distance from no building-_-_----_-________--_____--_-___--_--___. Distance to nearest lot line ----------- '�---- - ------ ---"----------------------------------------------------- Remodeling -•--- -------•--------------- ❑ 1` r Remodeling and/or repairing (describe):- `:-=----•----- ----------------------------------- ----------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ------ � � t �'I� i' " - the San Joaquin cal Health District. t ordinances. State laws and rules- and regulations of (Signed) :, "�� "------------- (O ,nee an Contractor) • 6 Ti BY 7 ------ -------- � i " ( 'tle� x :------------" (Plot plan, showing size sof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY P APPLICATON ACCEPTED BY-------------"----------- ---- ----------------------------------------------- DATE----------- _ P.EVl1 WI D BY ----------------------------------:----------- ------- — DATE ----------- i BUILDINGPERMIT ISSUED--------------------------------------------------------------------"--------------------------------- DATE-------------- -------"------------------ - -t Alterations and/or recommendat:ons----------------------------------"----------"-"----------- ------------------------------------------------------------ -------------- --=---- r - } -- ---------------------------------------------------- ------------------- ------------------------------------"------------------------------------------------- I ---------------------- --------•-------------------7-------------------------- ---------------------------------------------------------------------------------- ----------------------------------------- ----------- --------------- ----------------------- ----------- - --- --------------- ------- -"--------------------------------------------------------------- FINAL INSPECTION BY------- -------- --- ----'--------------------------------------- Date-'---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California is Lodi, California Manteca, California Tracy, California ES-9--2M 8-51 Revised W-2100