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1 � APPLICATION FOR SANITATION 'PERMIT Permit No. (Complete in Duplicate) ` Date Issued Application 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. JOB ADDRESS AND LOCATION-------- _` ------ ��- tiQ,.---- , - -y�--.�--��------------------------------ ---------------------------- ----------------- Owner's Name--------------------------------------- = --------C-...---- 4— ----------------------------- ------ Phone.- �p•�4:- 41 Address-------•--•------------------------------------- lr •- "-- ..... Contractor's Name-------- ------------------------------------------------ -- --------- Phone-------- Installation will serve: Residence"bi Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A_____ Number of bedrooms ___Sjj-___ Number of baths ___j___ Lot size ____ ------ a '� ----------------------- Water Supply: Public system ❑ Community system ❑ Private; Depth to Water Table ________ ft. Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes ❑ No�New Construction: Yes ❑ %No DGP— — --d 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__&O_r---Distance from foun-dation.l_r2__-----------Material------------___------------______- No. of compartments Size_ ____ �a-z �, p - -.�2--�------Liquid depth----.�:'.�-'-'--------Capauty----------------------- 6 3 ' d � .� Disposal Field: Distance from nearest weli--6t_��_.._.Distance from foundation____--_ _--_.Distance to nearest lot Number of lines______________-____�'________Length of each line'______: ----- .`_____._.Width of trench.___4t*-.-____.________� Type of filter material-____l_�i _ __Depth of filter material_---,8----_______Total length--- Seepage ength__ - �____________________________�} Seepage Pit: Distance to nearest well__________.._ _____Distance from foundation___________________ Distance to nearest lot line----------------- r ❑ Number of pits----------------------Lining material.----------------------Size: Diameter----------------------.Depth- -, - --------------------- 14 -------------------- r a� Cesspool: Distance from nearest well__"--_._____Distance from foundation---------------t___.Lining material__.________________._-_______________ 1!- ' Size: Diameter____. -_ s_�:=._______De Dent _ ' Li ujd Ca acit. __ als._ _ _ p.=---------- --ter=-. =T �..g ,..-- p y------••-----_----- - 9 Priv _ � Distance om nearest well__ ______________ _ ___Distance from nearest building------------------------------.____.___._- r i ❑ Distance to nearest lot line - ------------------------------------------------------ ---=------ --------------- � Remodeling and/or repairing (describe):--------------------------------------------------------------------------==--------------------------------- ---------------------------------------- -----------------------------••--•------••-----------•------------------------- -•---•---------••-------------------------------------------------------------------------- ti ------------------------------------------------------------------------------------------------------------•----------------------------------••-------------------------------------------------------------------- I hereby certify that I have prepare +his application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re4u tions of the San-Joaquin Local Health District. (Signed) C�- ----------------------------------- er Contractor) By:-.-. .. 1� ' ------------------------------------------------------------------------------------ [Ti+le) �'"-"� ---- [Plot plan, show ng size of lot, ibcation of system in relation+o wells, buildings, etc., can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___________ --=----^- ------------ ----- DATE__- ' REVIEWED BY--------------------------------- --- - --------------------- ---------------------------------- DATE ------- = BUILDING PERMIT ISSUED---------------------------- ---------------------------------- DATE----------~ 5---------------------------------------------- iAlterations and/or recommendations:---------- ------------- -------------- ------------------------------•----"-------------------------------.----------•--------------------------------------- -•-•---•--------------------------------------------------------•--------- -----------------------------------------------------------------•----•-•---------------------------------•----------------------------•---_------ ----------------------------------------------------------------- ------------------- --------------------------------------------------------------------------•--------------------------------------------------------- ----------•-------------------------------------- -----•--------------------...----- --------------------------------I-------------------------------------------------------------------------------------------------------- ; FINAL INSPECTION BY:-......... Date........ Z � .� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Noah "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M io-52 Revised W-2100