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APPLICATION FOR SANITATION PERMIT V Irmit Nol G - - — Duplicate) f (Complete in Date Issued f A lication is hereby made to the San Joaquin Locai Health.District for a permit to construct and install the work herein described. pp This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------a� / � ! ------- -----•---�.�--------- � ---- ----------------------------------- -------------------- stt c... --- Phone------------------------------------ Owners Name--------------------------------- •------------------ ------------- ' Address------------_------------------------------------�-—--Qt"' '+:'---------,-------------- ------ ---- -----------------------------------•---------------------------------- Contractor's Name----------------------••-- 0.,� ;" Ch 1k -'`1 ----------------- t- ----�'_._------------------ Phone.....-- ----- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other ❑ . (? /_v v Number of living units: I---- Number of bedrooms _1--- Number of baths _�----- Lot size ____ -------------- ----------- _________________ Water Supply: Public system RL Community system ❑ Private ❑ Depth to Water Table _Abft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ /Cllay�Loam ❑ Clay E] Adobeg Hardpan ❑ Previous Application Made:'Yes F1 No � New Construction: Yes �Nol❑ 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_ -4r_-Distance from foundation.__/1!___-____.Material__ `4` � -----• .. .� ' ��.�-� -�-�--�-----L-squid depth----'�--i' -- ----Capacity--- ------ ---"�`-`• No. of compartments_____�__________________Srze _ a 3.r .� Disposal Field: Distance from nearest well .Distance from foundation___ _----------Distance to nearest lot line__a__________ Number of lines------__-I-- ------ -------- ----Length of each line------ ------- Width of trench----- -5 •--------------- i Type of filter material _____ ilsr Depth of filter material_____fZ_'*'--""Total length_______;;n_____ _______________ Seepage Pit: Distance to nearest well-----AJ,:%-%A.._Dis nce•from f6undati f.1. __.Distance to nearest of line__ ______ Number of its_-.---- .3J..---. Depth-al--V7-- P I-------------Lining ma anal-�r_ _�_ ��_5ize: Diameter----- -- ------------------ Cesspool: Distance from nearest well-----------------D tante from founcla ' n------------------- Lining material_-_-__-__________________-"._..____-. ❑ Size: Diameter--------------------------------------Qep - ---------- --- •----------------------------Liquid Capacity------------------------_-gals. { Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------- ...___-- i ❑ 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 S Joaquin Local Health District. (Signed)---- - �" �---"�- � �'�'► �" Contractor " ----------------- _ � '°r ) ----------------- ---- ---------------- --------------------------------(Title)--- T�t�ie C1,�1� ( (Plot pls ing size of lot, locafionsystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYI APPLICATION ACCEPTED BY DATE- -- ----- - ---- ---- • IREVIEWED BY----------------------------------- - -------- -------------------- -- - DATE-----� -------- -------------- I. BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- -- DATE------------------------------------------------------------- r Alterations and/or recommendations:_-------------- ----------------------------------------------------------------------------------------- --------------------------- 0 -- ------------ ----------------------------------------------------------------------------------------------------------------------------- ----------- ------------------------ -------------------------------- ------------------- ---------------- ------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r ------------------------------------------------------ ------------------ ------------------------ ---------------- --------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- 11- FINAL INSPECTION BY:-- --- i'`-�-- ------------------------------ Date-----L_ - `------------------------------------ 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 B-51 Revised W-2100