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APPLICATION FOR SANITATION PERMIT Permit No. -Y6'_---.__ (Complete in Duplicate) i/ Date Issued -- 9 s''a Applica4-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. i'f3 -- CO3(7— 14c{2-4, JOBrADDRESS AND IATIQN 4fi !c_�x_ c> x /►.�t4 .- ec _ :-� Owners Name ., - f J j - ------------------------------------------------------ -- ! _ Phone- Addressr - ---'-------M-••W-le— ------------=-------------------------------- Contractor's Name --------------------------------_ •---------I--- Phone--,%Z,-.-- Installation will serve: SResidence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units: -----_ Number of bedrooms _ -IW"umber of baths _-a_ Lot size _ f--- --g Water Supply: Public system 0' Community system ❑ Private ❑ Depth to Wafer Tab1q.:e:�2;_ s Character of soil to a 'depfh of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam.❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: Yes ❑ No [Z�L New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank'or cesspool-perniitfed if public sewer is available within 200 feet.) .a Septic Tank: Distance from nearest well__A/`>. __Distance from foundation-+/0---- -----.Material---•`_=---------.-------�=� -.. No, of compartments------- _ _ •Liquid depth------- / _.----Ca acik4-,f_------ Disposal Field: Distance from nearest well!)._ Distance from foundatio�jn_ __---=_---.Distance to nearest lot line<<f -----__ ® tNusnber of lines------:-_�--.: Length.of each line_-_-_,�Z(�----------------Width of trench.----- __-_-- j ;+-------s' r Type of.filter,material---� ___ ter.'-f Depth of filter material------- __$1---- otal length------------'-5----0---------------------- _ r/ter( f - Seepage Pit: Distance to nearest well__---:- -LtT'?��istance from foundation Distance to nearest lot line---- ------ �r Number of its.`---- ---'--- ------Linin material=_ }_ s e: Diameter------ -- ---------Depth--------c:�e?0-------------- i Cesspool: Distance from nearest well-----------------Distance from foundation______--------_-___Lining material-_---------------___._ ❑ Size: Diar�eter-------- Depth ----- ------- - -- ----Liquid Capacity------------------------- gals. Privy: Distance from nearest well---------------------------------------------------Distance from nearest building----------------------------------------- F] Distance to Remodeling and/or repairing (describe):--=--------------------- ----------• -------------- --------------------------------------------------------------------------------- ---------------- -•• -------------------------------------------------------------------- --------------------------------- ------------------• -•---------------------------•----•------------•-------••---------------------------------------- -----------------------------•--- I hereby certify fhat I have prepared this application'and•fhat the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. , (Si ned ' 9 ]........ �r2 r' � =� ---- ----(Ow er and/or Contractor) 11 l BY: `' n -' =pL ��„!~ �x � -----------••----•---(Title)----- •--- -----------•------ ----------------- (Plot plan, showing size.of iot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,..r. ' FOR DEPARTMENT USE ONLY • APPLICATION ACCEPTED BY------------- - -- -----------------------------------------------------------DATE---- REVIEWED BY--------------------------------- -;--- --------------- ------ DATE---- - BUILDING PERMIT ISSUED. DATE ------------------------- Alterations and/or recommendations:---- --------------- --------- ---------- - _•-------------•---------- _ --- i - --•---------------------------- -------------------------------•------- ` �`r = -- - --- ................................. .-- --------- --------- -- ---- - ---__---_- ---•-- - , ------------------------------------------------------------------------------------ ----- ---•---------------- ---------------'--'Q ------""-""•---------_-.------------------------------------•--.--••_-- ---- -. FINAL-INSPECTION''BY:----. �_ -.... _.- 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