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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued (0 - 0 50 Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This appliCation is made in compliance with County Ordinance'No. 549. JOB ADDRESS AP LOCATION -----------A---CX_i_4�t -------------------------- Owner's Name-- ---------- ------- --------- ---- ------ ----------- ----------- ----- -- Address-------------- --------------- ---- . ...... Phone---------------------- 0.--- KIL ---- -------------------------------------- -- -- ------------------------------------------------------------------------------------------------ Contractor's Name----- --------1------------- --- ------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House E] Commercial F1 Trailer Court 0 Motel [] Ofh r F] Number of living units: J--- Number of bedrooms ._ Number baths ___L___ Lot size X-1/WK i I - - ------------------------ Wafer Supply: Public system E] Community system El Private ZDf epfh f Wafer Table -------- ft. 1 1 Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] Clay E] Adobe [I Hardpan Lj New Construction: Yes Previous Application Made: Yes F No ;�ON No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public t ewer is available within 200 feet.) Se nk: Distance from nearest well__%T19_____Dista froM,found2p&n-----LO-----Materi I---- ----------- Z % Si __IN No. of compartments----------- f----- ze --- ---Liquid depth --------- ------------Capaci --- ---- p I --- 41 -1 ----- -_ I . Dis Field: Distance from nearest well-. i,!__._..-.Distance from foundation_-- --------Distance to nearest lo 1,-------- P�l Number of lines_____________ _ .1--------- Length of each line----------IS0 It----.Widfh of french______________If------------ Type of filter material _��_ epth of Cfer rnafer;al------I X--------Total length--------------10-0--------------- Seepage Pit: Distance to nearest well----------------------Distance from foundatioK--------------------Distance to nearest lot line_________________ ❑ ine----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------ •� Cesspool: epth------------------------------ Cesspool: Distance from nearest well__'___-_--_- _D:stance from foundation--------------------Lining material-_-_______-- --------------______-__. i Size: aterial------------ ------------------------ Size: Diameter______________ _________Depth.----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__--__--____._______-------------------- F1 'Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------- ----- Remodeling and/or repairing {describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------I----------------------------------------------------------------I-----------I---------------I--------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------- -------------------------------------------------------------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. (Signed)__,&.A�_ ..... ------ -------- -----------------------------I----------------------------------(Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-----C>-------------------------I------------------- ---------------------------------------- DATE__��-- ---------------------------------------------- REVIEWED BY-------------------------------------- ----------------- DATE---------4-� BUILDING PERMIT ISSUED----------------- -- ------------- DATE Alterations and/or recommendations:__11:`'�e Z----V... - ------------------------I ----- ------ -------- -1- ----------- ---------------- CIA AX- -------------------------- ---Aft_ ----- ----------------q--- --- - - - ---------------------------------------------------- --------------------------1i--------------------------------------------- --------------------------------------- ------- ---------------------- ----------------------------------------------------- --------------------------------------------------- FINAL INSPECTION BY------------- Date------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 13,0 S*ufh American Street 300 West Oak Street 132 Sycamore Street 814 Norfb "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100