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APPLICATION FOR SANITATION PERMIT Permit No. ___-Sf P (Complete in Duplicate) e - L 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 r LOCATION.----/`/4 -/ � Owner's Name- l '-AL-q-��-------- i 0 ------------------------------------------------------------------------- Phone__ _�__ ~" Address........ Contractor's Name l'-L - kit 4 .4'' 1+ Phone ? ----------- Installation will serve: Residence 5( Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___.1__ Number of bedrooms J____ Number of baths ___t___ Lot size ------14�2Q---Y,_�(J_rov_ --________________-_____ Water Supply: Public system ❑ Community system '❑ Private K Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pq Hardpan ❑ Previous Application Made: Yes ❑ No JZF— New Construction. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well----S_ ___Distance from foundation______A�-I_.-_ ----------------------- __-________- No. of compartments--------;---------------- --------------Liquid depth---------7._-----------Capacity---M&O---------_ Disposal Field: Distance from nearest weld-----.5 --Distance from foundation-----J.6----------Distance to nearest lot line...%5_.. .rUr ____. Number of lines_______-___�I_____il_-__-_ _ Length of each line-------7-_4- --____.Width of french---------_2-_____________________ Type of filter materiali•�s'_ j_--Depth of filter material-----1C ___________Total length------- �1____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_.------------------Distance to nearest lot line__________•______ ❑ 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------------------------------------------------- from nearest building_-_________________________________-____. ❑ Distance to nearest lot line ------ --------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------- --------------------------------------------------•-------------------------------------------•------- •-•-------- --------. -------------------------------------------------------------------------------------------------------------- ---------------------------•-------•-----------------------------------------------------------------•--------- -----------------------------------------------------•------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------.------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. E - f (Signed) --------- "--- -- + ----- �?_ 'Ca ------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Tif le)----------------------------------------------------------------- (Plot y:------------------------------------------------------------------------------------------------------------------------------------(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_----�-•-- ,r REVIEWEDBY------------------------------ - --------------------------- DATE------ -------------�-.------------------- ----- BUILDING PERMIT ISSUED-------------------------- ------------ ------------ ------- f D A%,TE----(-------------------------------------------------------- Alterations and/or recommendations:_ FINAL INSPECTION BY:---------- - Date- --------- -J- --------------------- 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 a �