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APPLICATION FOR SANITATION PERMIT Permit No. _3_' .. (Complete in Duplicate) ll ap Date Issued{.©__' r'. pplication is her by made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i de in compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION-----2,5-15--- ............ , Owner's Name--------------1.aa ._c__LLe_W_1,9-------------------------••----------•----------------------- --- --------------------------- ----------- Phone---5-7g T--------------- Address--------------- -------- - Address-----------•------------------qg']e --------------------------•--•------------------------------------------------------------------------------------------------------------------------------- Contractor's Name---------------------_De1_ir:a_,_--Ina-------------------------------- •--------------•-----•--- Phone---3-395.5----•--------•- Installation will serve: Residence [K ' Apartment House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms ___2_ Number of baths .1-__. Lot'size _______________60x 20-------__----_---- 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 ❑ Adabel] Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ 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_________________Distance from foundation-------------------.Material -________-__-__.__.________-____________..______. Ex I S[Qing No. of compartments--------------------------Size---------------------------- ---Liquid depth--------------- ---------Capacity---------- ------------ Disposal Field: Distance from nearest we{i----------------Distance from foundation--------------------Distance to nearest lot Cine________ ______ ExIslling Number of lines-----------------------------------Length of each line------------------------------Width of french.----------------------------------- Type bf filter material------------------------Depth of filter material---------------------..Total length------•------------------------------.-_-- Seepage Pit: Distance to nearest well. -----------Distance from foundation______ Distance to nearest - lot line_____5--r ® Number of pits.....1_____________Linin9 materialbn!_Qk--------Size: Diameter__.__ 1------------Deph------ --- -- -_-_---_-_-_ Cesspool: - Distance from nearest well-----------------Distance from foundation------------------- Lining material___-------------------------------------- ❑ VSize: Diameter--------------------------- ----------Depth---------------------•------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________________________________________ Distance from nearest building-:--------__-------_____________.______ ❑ Distance to nearest lot line_____________"----- Remodeling and/or repairing (describe):-------------Ye>'t_--------------------------------------------------------------------- -------------------------------------••----------------------•-------------•••-----• ------------------------------------••-------------•-----------------••----------------------------------------------------------------- ----------------- ---------------------------------------•----------- -----•----------------------...---•--------------------------------•---•--------••----------------------------•----------------------------------------- ------------- --------------------- ---------------------------------------------------------------------------•------------------------------------------------------------------------------------------•---------- ------ 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. I (Signed)-----------------1)Q1_1A......!no-------------------------- ----------------- --------------------------------------------------------------.(Owner and/or Contractor) .- ---- ---------- BY=-_------------------ -- -------- ------- --.....�'_�----�-•----�'�-•----- -l 1��--v"-'- - -- - - - - Title ------ em•---M r. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - '-------- ---------------------------------------------- DATE---- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE-------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- Alterations and/or recommendations-------------------------- - - = -ll ---------------•--------------------------------------------------------------•------------...------------------------•--------------- I ----------•------------------------------------ ---------------------------------------------------------------------------------------- --------------------------:---------------------------------------- ---------•---•--- --------------------------------------- --------------------------------------------------------------------------------.------------------------------ •------------------------------------------- -------------------------------- FINAL INSPECTION BY:.....`�------------------ ------ Date------ 0 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