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( APPLICATION FOR SANITATION PERMIT Permit No. _-_ :. .. (Complete in Duplicate) �� q , , „.. Date Issued ____"_•ate^---------- Applica+ion 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. (81DO Alk, O: O on ) Te s'tlVe Mb's' * SO J JOB ADDRESS AND LOCATION-- - ------------------------------- ------------------ ------- ----- -------- ----------------- -- - --- ---------- -------------- - ---- Owner's Name ISI ine tTtdhmoli* P aton Contr, Tom WIAton Phone '_�--��-•69 } 1 `ti--•----i------ - --- -- - - --- --------------- -- - ------------------------------------ Address...........--------------------------------•- �� $��. .t? F4 tics Contractor's Name---------- - ••----------•---------------------------------------------------------------------------------------------------------- Phone----------------------------- - Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __'�_`__ Number of bedrooms X Number of baths .-• _ Lot size � Water Supply: Public system 4..Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth.:of 3 feet: =.Sand ❑ Gravel 0 Sandy Loam❑- Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes E] No �New Construction: Y es+ D No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 leegt j BrIck' Se i Tank: Distance fropm}nearEst Y211----------------- -as r udatio --.-tt--��------`-----.Iv� iial---------------P-_ * - 1j �+ No. of eom artments______--�-------__Size ___ Liquidde th______________-_._______Ca aci _______ 11 _ _ 9T -4 bis osa8 Field: DistNumabee of 1 nesfrom ear st 11 == _ Distance th of,rom each line a{I _:-� ______-Widthcofttre cal tpl�i ---~'' Type or'filter material_____ _____________Depth of filter material___-______ _._Total length_____"____:_--__..-;-._-__-_-. .____.__._. -- v 0 s 1 Seepage Pit: Distance oto nearest w l- ___Linin mDteraal_ o tion- _____________D' ce to nearest lot i ;�------------ p 9 ize: Diameter------------------------Depth-----w �. --- Cesspool: ' from nearest well from foundation. material ____.____'_:_ '__------------------- ---------------- 171 _-________________ Distance • - ❑ Size: Diameter p - --Depth_ - -- - -"-=----Liquid Cap acity---------------------------_gals. Privy. Distance from nearestwell---------- ------ - -------------------------- Distance-fromnearest building : . ❑ Distance to nearest lot`lirie_A'" " .._. � -- - -------------$ ---------- ------------•-------------------------------- --- --- - Remodelingand/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. (Signed)._-. =---- ------ - Cwner"a,J�or Contractor) �. ,A •; r ,�, � r ��1 - "" , ' ..'----------------- Tale ey:..... ;------- ------------------------------------------------------- { ).. (Plot plan, showing size of [of, location of system in relation to wells, buildings, etc., can be placed on reverse side). -Ile ,.�. FOR DEPARTMENT USE ONLY BY ---------- -----A - DATE L__ ��---------- REVIEWEDBY--ACCEPTED-------------------------------------- -------------------- ----------------•---------------------- DATE L/ BUILDINGPERMIT ISSUED----.-------------------------------------------- ------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:----------------- ----------------------------------------•---•-------------------•--_____----•--------------•-------------___.......................... ---------------•---------------•------------------•-•------------------------ ---------------------- ----------------------------------------•------------------------------------------------------r------------------------ ---------------------------------------------------------------------------- ------------------------- ------- -------------------------- ----------------------- -------------------- - 5 FINAL INSPECTION BY-- --- --------------- Date v 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