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r, �3 ' APPLICATION FOR SANITATION PERMIT Permit No. a.-C. --.-�:. (Complete in Duplicate) ! / "y Date Issued _____ _____ __ Application is h re made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is de in compliance with County Ordinance No. 549. t' � - JOB ADDRESS AND LOCATION_______ ____ _ Owner's Name-----+�rA[------ to °__.-_-- Phone. . ------ ----__:----------------------------------- -------------------------------------- -- -------------- Address__.... ./rs_ _-__._. �- _-- -------------------------------------------------------------------------------------------------------- ��-D4. 2 L Contractor's Name--------.... ----Ae -------------------------- ---------------- Phone - - - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -tZ ___ Number of bedrooms __Y_ Number of baths ________ Lot size__-_--t:�-�_�_�-_ Water Supply: Public system system 0 •Private❑' Depth_to Water Table l�..A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑.�Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: YesX No ❑ TYPE OF INSTALLATION AND'SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestweAn _Distance from foundatio _--/®. .......Material _ _ _ __-..._---.._._-. "No. of com artmenfs _____________ XA _ � 11JR Disposal Field: Distance from'ne_arest well_�)PM�4:YDistance from foundation__��__......_Distance to nearest lot line................. 3[1 u��_ 2�_"Vidth of trench------'2-`'�"________________ Number o? lines____________________________p______Length.-of each line__ _ ___ _ Type of filter ----Depth of filter material ____L_9..........Total length-------400--------_-_--------------- Seepage Pit: Distance to nearest. well_ / w _DistanceI from foundation____ __.___.Distance to nearest lot line----------,_. ..__ l . 5.�________________Number of pits_____�____________Lining materia .__.._ _. `Qn i Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------� ❑ Size: Diameter------ !--------.-----------x--------Depth- t------------------------------------------------Liquid Capacity----------------------------gals. " l Privy: Distance from nearest well--------------------------------------------------Distance from nearest building..__.__-_--_-----_------_--_-----------. ❑ Distance to nearest lot line----------------- ---------- ------------------------------------------•---------------------------------------- - ------------ -- ---------- 1• ( Remodelingand/or repairing (describe]:--- -------------------------------------:--------------------------------------•-•-------------- ---- -------------------------•------------------------- Z ----------------------------------------------------- t I ------------- ----•--------------------------------------------------------------- ------------------------------------------------------------------------------------------- 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. Si ned �i '�` ------------------------ ._ O ne�and/.or Contractor{ 9 ) ---------------------------------------- - ----------- ------ { BY: (Title)- (Plot - ------- ------ ---- - ----------------------------I--------- ----------------- (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - S - - - ---- -- DATE -"� 1 -A,,>------- - REVIEWEDBY------------------------------------------------ -----------=----------------------- --------------------------------- --------- DATE-- ------------ --------- •------------------------•------- BUILDINGPERMIT ISSUED---------------------------------------------- ------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations------------------------------------------------------------------------------------------------ ----------•-----------_-•-----------------------•------------ ------------------------------------ ----•----------•-------------------- ---- ----------------------------------------------------------------------------------------------------------------------------------- ------ --------------------------------------------------------------------- ---------------------------------------------•--------------------- ------------------------------------------------------------------------------------------------------------------------------ ----------------- FINAL INSPECTION BY-------------- -------------------- -------- ----------- - Date------------ ---------- --------------------------------------------- a ' 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 10-52 Revised W-2100