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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�wifhunty Ordinance No. 549. -1 JOB ADDRESS AND LOCATION_ _. --- ----- t _1q - --- --- ----- ---------- N -------------- Owner's Name-------------------------------- 1-J-2— C1_<---•-- ---------1'_�Jy. ----------------------------- Ph o ne- Address--------------------------------------------- ---- 7 -- ------- ------------_ I___ ----------------------------------------------------------------------------------------------------- Contractor's Name--- --- ---------- --- 2.1�1=---___/�__W__C!�----------------------------------------- Phone_� -q;!r-2 Installation will serve: Residence Trailer Court [] Motel F] Other ❑ Number of living units: _1Apartment House [] Commercial--- Number of bedrooms _1_'Number of baths I____- Lot size ------------------- ---- Water Supply: Public system 1A Community system [:] Private E] Depth to Water Table egs.—ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay El Adobe K Hardpan E] Previous Application Made: Yes E] No New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet) Distance from nearest well_H0NAF_'__Dis+ane kom foundation----(0....-------M,terial---- ........ GZAZ �Mp No. of compartments---�Z—-----------------Si -E,.D , -,d clepth._3,0..............Capacity---111,90.!F4 V--------- --Li Disposal Field; Distance from nearest well________________Distance from foundation- -----------.13istance to nearest lot line__151 Number of lines_____ ---------Length of each line----- Width of trench- ---------- X if-------- - Type of filter me 1_&_U_C__Depfh of filter materia-7 /Y - 4- ------------Total length-------14 S----------------------- Seepage Pit: Distance to nearest weft____________ _______Distance from foundation---------------------Distance to nearest lot line_______._____._._ ❑ ine----------------- El Number of pits------------------ Lining material----------- -------Size: Diameter---------.-------------Depth--------------------------------- Cesspool: epth----------------------- --------- Cesspool: Distance from nearest well_________________Distance from foundation----- ..............Lining material__.___._----.----_________________. Size: Diameter-------------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------- ---------Distance from nearest building_____..__--_----___________________..._. ❑ uilding---------------------------------- F1 Distance to nearest lot I' P- ------------------ - --- ---------- Remodeling and/or rep ).,XAGK4_ �------ ------------- - --- - - - ----------------4 ,airing (describe) ----- ------------- --- --- --- ---------- ---- --- ---/--- -------------- - -----------------I---------•------------ -------------------------------------- -------------------------------- ------- - --------------------------------------------------------------------------- ---------------------- ----------------------------------------------------------------------------------------------- ----------------------------- I hereby certify at11- aveprered this application and that the work will be done in accordance with San Joaquin County ordinances, State laws', and rul and regulations of A San Joaquin Local Health District. I (Signed)-------------= -- ------- ---------- ------ 7_4�__ , .... .. ... .. . ................. .. By:------------------------------- --- ---- --- -- -----------------Z ---3 (Plot plan, showing size of lot, location of system in re:laio3-n---t ij_�CMY--------(Titl w p, wells, buildings, etc., can be don reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------- ------------------------ DATE - --- ---- - -------------------BY------------------------------------------------------------------------------- -- ----6-1 ---------------------------------------- DATE--------- -- -- -- --------------------- BUILDING PERMIT ISSUED-------------------------------------------------- --------------------------------------------------- DATE Alterations and/or recommendations------------------------------------------ --- -------------------------------------------------- -------- ---------------------- -----------------------------------------------------------------------------------------I---------------------------------------------- ---------- --------------------------------------------------------------------- -----I------------- ----------------------------------------- -- ----- --------------------------------------- ---------------------------------------------------------1----;------------------------------1-1---I------ -------------11--------------------------------------------------------------------------------------------------------------------------------------------- -- ---- ---------------------------------------------------- -------------------------------- -------------------------------------------- --------------------- -------------------------I-------------------------------------------------------------- -----------I-------- FINAL INSPECTION BY----------------------•-------- ---------------------------- Date--------------.. -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814N*rfh "C" Street Stockton, California Lod;, California Manteca, California Tracy. California ES---9--2MI0-52Revised W-2100