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f t�� S�_q 1 / Y APPLICATION FOR SANITATION PERMIT Permit No. . . 1 (Complete in Duplicate) 3 /��+-I Date Issued - --------- pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d scribed. This application is made in compliance with Counnttyy Ordinance No. 549. JOB ADDRESS AN CAT�OJN, /211?.---- . ------------------------------- ----------------------------------•------------ Owner's Name-------- -------- --- - -------- --c-G'� ---------- -- ---------------------------- --- ------------------------------------- - Phone------------------------------------ Address----- -- --- --- ---- - - --- -- ----------- ----- ------- -----------• ------------ --------------------------------------- - ---- -------- .2 11 Contractor's Name----------- ------ ------------` -- - --- ------------ -- ------- ------------- ------------------------- Phon ... �? Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - __ mber of bedrooms _P'& Number of'baths .A"-Lot size --_ -------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table.,. -_ ft. s Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest All21._Q. Distance„from foundation----l-s`._.__M0t ial----------------------------------------------- No. of compartments....__(`'_ S(o D' q • p p F -------------Size-------- �=y ------- ----•Li Liquid cfe th --��--------------Ca auty---9-0. V---�- Dispos Field: Distance from nearest welL,;)P!.._.Distance from foundation---3A:..........Distance-to nearest lot line__5---_-__..- Number of lines------l______i Length of each line-------So.-----.---_.-.Width of trench.___. __o _ Type of filter material-_ _. eC4-___-Depth of filter material------- length--_-_-.________________________________n Seepa Pit: Distance to nearest well_7 istance from foundation-__et©__........Distance to nearest lot line-„- Number of pits_____1__--_.-----Lining material ---Size: Diameter-----y9-----------Depth-_-_-_.�______ ............. ..+- 1 1 Cesspool: Distance from nearest well-----------------Distance from-ofoundation-------.-----------.Lining material-------------------------------------- El -_-___.---- .------..-.-------_-_.❑ Size. Diameter--- ------------- ---------------Depth_---I--- ----;-------------------- ------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ------------------.----_r-__ _ Distance from nearest building--------_-._-_________----_-..----.----. ElDistance to nearest lot line---F--------- --'------ ------------------------------------------------------------------------------------------------------------- r A Remodeling and/or repairing (describe): ' +-----------------•--------------------------------------------•--------•---•-----------------.------------------------- ----------- • k } ------------------------------------------------------------------------------------------ ------------------------------------ ---------------------•- ----------------------- I hereby certify that I have prepared this application and tkat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regylations of the San Joaquin Local Health District, {Si ned � Own6�r and/or Contractor g ) ---- ----- -- �� - ---�-�-, --------- ----------------------------------- a / ) BY:-- --------- �CrL-- --------------------------------------------------------- Title --------- (Plot plan, showing size of lot, location of sy. m in relation to wells, buildings, etc., can be place an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------t DATE .,..• REVIEWED BY--------------------------------------------------------- ----------------------- DATE----- ---------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations------------------------------------------------- ------------------------------------------------------------------------------•-•---- ------------------ ------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- ---------------------------------------------------------------------- -----------------------------------------•--------------------------------------------------------------------------------- AneA FINALINSPECTION BY: v-- -------------- ---------------------- 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 : - Revised W-2100