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APPLICATION FOR SANITATION PERMIT Permit No. _All. ..!_._. ._ (Complete in Duplicate) D S, r 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 Ordinan Na. 549. ee�� - JOB ADDRESS AND LOCATION------�4 �-.7i___a. —AAR_k-- stcr _ e �y Owner's Name------------------------------------- ..._�� A >�_ --�[ . rPv Phone Address- e2"7---C----_--------------------------------------------------------- ---- - Contractor's Name------------------------------- -------------------------------------------------- ----------------- Phone----• 9=,f Oyu Installation will serve: Residencet�g_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number-of living units: __ _- Number of bedrooms Number of baths ./---- Lot size h r % r0._-_________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 001-0 ft. Character.of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, .Hardpan ❑ Previous Application Made: Yes ❑ No j4— New Construction. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S j�ak,/,—Distance from nearesi well-----------------Distance from foundation--------------------Material-------------------------------------____________. No. of compartments--------------------------Size---------------------------- ---Liquid depth---------------- - -------Capacity---------------------- 4 a Fi Distance from nearest well__&:^ -__Distance from foundation_____Af__a_�_.Distance to nearest lot Number o-i lines--------/------------------------Length of each line-JO -- ----.Width of tre�naZ-j"__ '��__ -1 .l t� { r Type oT' filter material____�2_ ._��___-Depth of filter material------1_1---------Total length--------------w-Q-_____________-_._ Seepage Pit: Distance to nearest well... .__Distance fr m f undation___jl�49'7n_ Distance to nearest lot line---- d_r Number of pits------I--------------Lining material_ _ _ Size: Diameter__ '3.111_____-Depth_-_-:2___j- ----------------- 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--------------------------------------------------------------------------------------- ------------- I Remodelingand/or repairing (describe)------- ---------- -------------- ------------------•---------------------------------------- - -----------___•------------------------------------ -•--------------------------•-----..------------------•------------- •----------------------------•-••------------------------------•------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- j ------------------------------------------------------------------•----------------------------------------------- ----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance a ws, and rule nd regulations of the San Joaquin Local Health District, s (signed}- - --------------------- - ----- Contractor) ---------------- Title 4_ (Plot plan, showing size of lot, location of system in relati n to wells, buildings, tc., can be pla a on reverse side). FOR DE ARTMENT USE ONL APPLICATION ACCEPTED BY------------------------------------------ DATE-------------- :- - - REVIEWEDBY-------------------------------------------------------- ------------- DATE--------------- - .� BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------ a -/ Alterations and/or recommendations:------------------------------ ------------------------•--•------------------------------------•-•-----•-----------------------•------ ----•---------------------------------------------------•-------------------------------------------------------------------------.....----------------------------------------------------------------------------------•- ----------------I---------------------------- ----- FINAL INSPECTION BY:--------------------- '_ 7i�I --------- Date----------------- ------------------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ' Stock+on, California Lodi, California Manteca, California Tracy, California 1 j ES-9-2M 10-52 Revised W-2100