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APPLICATION FOR SANITATION PERMIT Permit No.%1•_---_-----a•------- �� (Complete in Duplicate) 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. f 77 - 230-0�' JOB ADDRESS AND LOCATIION-..4�---09//7_&----,e -- �� i--- lC ------ - - -- 2 ----------------------- Owner's Name - 4� T . �� ----------------------- Phone-4-47- Adres ----------------- � 6w��_ ----•- `�1_� , '' '•-` rT -------------------------------------------------•-••------------------------------- Contasctor's Name--------•-------•------------- i � --0 � � t ------------------------ Phone---f= Q Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms ________ Number of baths I------ Lot size ---------L&OZO------_--_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Ar ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeXL Hardpan ❑ Previous Application Made: Yes ❑ No Q New Construction: Yes ❑ No ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------.Material-_____.-__--__--________-_______-_____-_--.__ ; ❑ No. of compartments --,-Size--------------------------------Liquid depth--------------------------Capacity------------� --- Disposal F'selci: Distance from nearest well-> Q_-�-Distance from foundation,Il�A --------Distance to nearest lot line---§7---_--- Number of lines-----/-------- _� __L_ _-_Length of each line_-____.____�-'0----__-----.Width of trench___--- �F1__-._---_..__---- Type of filter material____ 1��___Depth of fitter material__. �_"_____.__Totai length_______��__Q_________________________ Seepage Pit: Distance to nearest well-_-___________________Distance from foundation--------------------Distance to nearest lot line_-.______--_-_ I ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------------___.Depth______________-_________ __-- - Cesspoo • Distance from nearest well-----------------Distance from foundation----------------..-.Lining material_-_______._-_._______--__-_-_-_____ t ❑ Size. Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity _:: _ - =girls: P69G - ' -Distance from nearest well-------------_-----------------------------------Distance from nearest building-__-___._____________-_______,______-__. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-_------- ----------•- f��-�i-*�r - a-----------------------•............... -----------------------------------------------------------------------------------•-•----------------------------------------------------------------------------------------------- -------- ----- - 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, a rules and regulations of e San Joaquin Local Health District, (Signed - 1 Q - --- - - � -"M ( r Contractor) By:----------- ---L (Title)- ' (Plot plan, showin size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ = n DATE_ - ------------------ --------------------- REVIEWED BY---------------------------------- '----- —----- DATE �'�"� �� BUILDING PERMIT ISSUED-------- ' -- -___ '_- --------------------------------------- f DATE Alterations and/or recommendations--- ---------------------------------------------------------------------------------------------------------------•------------------------------------------ -----------------•----------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-- -----------------------------------•- ,Date-----.--- 4- _7------------ •-- - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Stree# 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi. California Manteca, California Tracy, California ES-4-2M B-51 Rovised W-2100