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APPLICATION FOR SANITATION PERMIT Permit No.al_.3 (Complete in Duplicate) q ' Date IssuedV - _I_ .- Application is here ads to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is ma a in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION____ -------------------------------------------------- Owner's Name- _ . hone--- -- -- ------- ---- ------ -- �--- -------------- --•---- �-^-- --- � �- ------------ Address ------------ P i ----------- ^� Contractor's Name_____ ------Ls� ~ ---------------- Phone----- 2 L Installation will serve: Residence apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---r-_ Number of bedrooms -------- Number of baths -------- Lot size ___ Water Supply: Public system [f--c—ommunity system ❑ Private ❑ Depth to Water Table sr?_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ET--Hardpan ❑ Previous Application Made: Yes NoConstruction: - = ❑ �-- New Yes ❑ No [L�-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesi well________________Distance from foundation-------------------- No. of compartments-------------------- -----Size--------------------------------Liquid depth----------------- --------Capacity------------------ ---- Disposal Feld: 'Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line___-.-_.___-____-0 Number of lines_-.-_-._____.._ ' ------------------Length of each line------•-----=--- ------------.Width of trench------------------ �------------ Type of filter material_________________________Depth of filter-inaferidl-----------------------Total length------------------------------ ----- Seepage Pit: Distance to nearest well,,j?.P_v-4__ Distance from foundation_____-W_g---.Distance to nearest lot line-----� -_._ Number of pits.-------I-__________Lining material__C.�_�_ _ .'.Size: Diameter------�L-a- ----Depth- rr` cl « _�- - Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-________--_-________._ Size: Diameter------ --------------- -------------- Depth------------------------------------------- - ------Liquid Capacity--------------- gals. Privy: Distance from nearest weli--------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (descriL�e):__ .-*--'---+- °---`-- •-------------------•-----------------------------•-----------------------•----------------- --------•---------------------------------------•---------•-----------------•-------------------•---------------------------•------------------------------------••------------------------------------------- I hereby certify that 1 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. (Signed) •••'+.• �i` +.� `°''�-'----'�� 1 --------� � Contractor) By:.__ t ----- --- -- ------(Title)--- .w - - -------------------------------------------- -- ot 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------ - ._ REVIEWED BY----- ------- --------- ------ --- ---- ----- ._ DATE------ - -- ------------------------------•-----------------•--- - -- -- -------------------------- UILDING PERMIT ISSUED------------------------------------------------- ----------------------------- DATE-.---- --------------------------------- Alterations and/or recommendations:------______________ --------------------- ------------------------------------------------------- ------------------------------------------------------ --------------•------•------- ---------•-------__--------- -- ----------------------------------------------------------- ---- ----------------- ----------------------------------- � FINAL INSPECTION BY:.___---�_'_� <�-� ------ ------- Date__---; 16 ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100