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• S'd APPLICATION FOR SANITATION PERMIT Permit No. r� o � (Complete in Duplicate) o Date Issued 4_"��-":�D�^' Application is herebymade to the San Joaquin Local Health District foraermif to construct 1 This application is made -in compliance with County Ordinance No. 549. p and install Iles work berein described. r /��ti J e5 5 u y) b i,c,C JOB ADDRESS AND LOCATION-------------- ---- _ qJ" - ------------------------------------ Owner's ------------------------------ ----------------- ----------------------------- Name______________ ---- ------ ----------- ------------------ Address --- Address-------------------•-- -44-+ ` " Tp� r �l�__�.�1_.__ Phone ---- - -- Contractor s Name--------------- _ . --------------- �c" . -�-6— -------------------------------- - -------------------------------------------------- : Phone ------- Installation will serve: Residence X Apartment House E] Commercial 0" Trailer Court [] Motel E] Other E]Number of living units: ___/___ Number of bedroorrs ff-_ Number of, baths --/-- Lot size ______ Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand X Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe ❑ Hardpan Previous Applicafion Made: Yes [:11 No "71 New Construction: Yes rV No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p sc_ r -- Se fian Dist`an`ce #rem:riearestawell--- Distance•frbm-foundation- - s� i Disposal Field: Distance from nearest well___�[� Size �'�� ___ - � Liqudepth id __� _________________Ca pa f„�[�Q'�"�94y;_ - No. of compartments_____ -_ p ty Distance from foundation_ __ Distance to nearest lot I�e___ � Number of lines_____________ ____Length of each line_________ _(� Width of trench________7---------------- Type of filter material "" a` " t Depth of filter material________ ___ Total length_________________" Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________Distance to nearest lot line_________________ ❑ Number of pits-A----------__----Lining material----:------------------Size: Diamefer-----------------------Depth--------------------_" ----------- Cesspool: _ Distance from nearest well_________________Distance from foundation--------------------Lining material_________---____-________--__ ❑ Size: Diameter--------------------------------------Depth- --:------------------------------- --------------Liquid Capacity gals. Privy: Distance from nearest well---------------------------------------------------Distancc from nearest building ❑ Distance to nearest lot line----------------------------------------------- Remodel;ng and/or repairing (describe):_-____ ----------------------------------------- -----i-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------•------------------"--------------------------------------------------------------------------------------------------------------------------------------� . --------------------------------------------------------------- - --------------- - -------------------------------- ere ycertify 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}•----� -�----' - -'�----------- -------------------------------------------------- i Owner and/or Contractor By:------------------•----------------------------;-----------------------------------��---------------------------------------------(Title)------------------------------------ -------------------- ] (Plot 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 ------------- BUILDINGPERMIT 1SSUED--------------------------------------------------------------------------- ------------------------- DATE Alfe,ratigns and/or recommerhdations--------------------------------- ----------- _ _J ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------•-------•---- - FINAL INSPECTION BY:____:----- .---------- ----- Date--.----------1.6 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