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\ APPLICATION FOR SANITATION PERMIT Permit No.,,_5_,:3_7�.-__. (Complete in Duplicate) Date Issued Applica{ion 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------. / ..d,--- �} -- ---- - .. - -------------------------------------------------------•----------------- ------------ --------------- dOwner's Name-------- -- - -- ---- �. -------------------------------------- ---- hone JSP P -- - ----- -------------------- Address----------- -- -- ------- Contractor's Name-------- - -- ---- -` ' ` .__ Phone-- ------------------ Apartment - ° G -• -•------------ Installation will serve: Residence A partm ent House ❑t Commercial'❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Numller t f bedrooms _�_ Numb' of baths _�--- Lot size -__-___6010' ~ 0 .,�/.? ------------------------- Water Supply: Public system ommunity system [] Private ❑t Depth to-Water Table'! - tt, t Character of soil to a depth of 3 feet: San Gravel ❑ Sandy t am Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: Yes ❑ Noi Ncw"Construction:••Yes i No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if fapublic sewer is available within 200 feet.) pti�ank: Distance from nearest well_f---------------Distance from foundation----- --,.---------Material _----_____-.-_ ---------------- No, of compartmentsl.-----If Size---------•----4----------------Liquid depth-- -----------------Capacity----------------------- Disposal ield: Distance from nearest, well.................Distance from foundation--i '-------_..Distance to nearest lot line-__--_-..__-----. Number of lines--------- engt of each line------------ -------------Width of trench-------_------------------------ Type of filter.mai-eriaL____ ___---_____-_ _ ,,. _ Depth of filter material-----#------�---__----Total length------------------------------------------ Seepage -- p 9 _Distance from f undation-__. 4__-_---...Distance to nearest lot line--'z.S^_�___ I e See a e Pit: Distance to nearest well_ 4_W__- Number of pits-------f ----- _Lining_-material,--a_�__-_ _-Sii6:'Dia Teter---- - ��__..__---Depth--------------------------------- f Cesspool: Distance from neare .well--_-----_._,.,,-_Distance from foundation-----------------_Lining material----------__-_-----.__-------_ •e ❑ Size: Diameter------ ---------------------- ------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building V' ❑ Distance to nearest lot line------------------- -- ----------------------- -------------------------------------------- Remodeling and/or repairing (describe):------------------ --------------------------------------- ------------------••-----------------------------------------•----------------------------------------------•---•-----------------------•--------------•---•-----------------•----•----------•---------------------------- -••----------------------------------- - ----------------------------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and re=tionse San Joaquin Local Health District. (Signed)_ -______ ------------- - -------------------- -------- ---- -------------- - _(Ow r and/or Contractor] 8y:. .E.. - =--4 - -- R_ l----------------------------[rtle] - -- --- --- ---- ---- ------•----------- (Piot plan, showing size of lot, location of system in relat' n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------ DATE- -------------7.,._-f-).� ----------- REVIEWEDBY ------------------------------------------------ -----------------------•-------------- DATE--- --------------------------------------- BUILDING PERMIT ISSUED------------- -- ------------------------------------------------------------------------•------------ DATE.--------------- -------------------------- Aterafions and/or recommendations:---------------------------------------- -------------------------------------------•-•------- --------------------------•------------------------------------------------------------------------- -------------------------------------------------------------'---- - - --.__.-_---_._.____-----'_9' rwi FINAL INSPECTION BY:........... y Date 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 ; IRevised W-2100