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f APPLICATION FOR SANITATION PERMIT Permit No. ... '(Compiete..in Duplicate) w 6 • - �, T _.. . Date`issued --- --- ------- Applica;ion is hereby made to the San tJoaquin .L`ocal 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-] -----------------OCATION__ __lJ�`- `� - -------------------------=------------ Owner's Name -----------'-----=--- - ------------------------------------------ Phone---------•------•------------------- 1 w .. - -- Address,,Al- ._.... . .. � Pf-----_�- ,� ,------- --------------=------------------ -------------------------- I Contractor's Name.____'___ ------ Installation will serve: 'Residence De Apartmenfi House ❑ Commercial-'❑ Trailer Court ❑ Motel ❑ Other Number of living units: __--'-_--`Number of bedrooms -------- Number of baths _______ Lot size ----------------------------------------- ------------------ i Water Supply:" Public system ❑ Comrnunity system ❑. Private [3 Depth to Water.Table :_`__=_'ft: Character of soil to a depth of 3 feet: Sand '❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous A lication Made:' Yes No 'New Construction: Yes No r Pp ❑ ❑ ❑ ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: " 't`� ' [ aseptic a� sp p la �f publ.i.c sewer is a�va.il~abyle. viithi 2ti 0�•0 feet.) Septic Se tic ak4Fstancefrom'nearest well----------------- -Distance from foundation--------------------M.,a^Material=------«-,-.!t`-.--,-w--.-==_--,--------.--.- -------f--------T-v-- i ❑ o. of compartments------ - t - = -----Size ------ ----•------------=---Liquid depth--------------------------Capacity------------------= Q ---- Disposal Field: Distance from nearest well_"________ Distance from foundation________.___....Distance to nearest lot line-----------------� ❑ Number of lines------'-'-------------------------Length of each line----------------------- _-----Width of french.----------- ------ Type of filter inateriaLr_# ----"---- __--:Depth of filter material-------------- --- -`____Total length------------•----------------------------- r _ Seepage Pit: Distance to nearest,wellp�'_____________:.Distance from..foundation....................Distance to.nearest lot"Iine____-__--------- ❑ Number of pits-------- __E---Lining material---_-------••--:-'_.--.Size: Diameter-------=-----'--------_Depth--------------------_------------- T_. Cesspool: .- Distance;from nearest well__- °___ '�__-Distance from foundation________:.,__-____.Lining'material___.____._____.___._________________ Size: Diameter.--_-------=----'- ._ De th _:- ----Li -------------- Liquid Capacity - = Distance from nearest well------------------------------------------ __._Distance from nearest buildin --------------------------------------------- Privy: �` . '� Dis#a nce'to'nearest'lot"line._:: J------------------------------------------------------------_ .� . -=--------------- -------- r - y�- -;- d t iE rj0 rt e `�� f M .1�- Remodeling and/or repairing l [describe): :_" *_-- x ' - -��^c ..-------- • o r E •----••-- -•---- - ....... - •------------------- ------•-•-------------------------------- ----------------------------------------------------- - i --. I hereby certify that] have prepared-this arolicafEon'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. r ---- - - ----- er and/or Contractor) ) IBy---------------- _--�••�---•---- [Title) (Plot pian, showing size of lot; location-of system i rn�elation to wells,lbuildings, etc., "can be placed:on reverse side). I f f FOR DEPARTMENT USE ONLY . REVIEWED BY---------------- - _ �`„ }__.�<--- --------------------=---- •-=----_ DATE i. APPLICATION ACCEPTED BY--- DATE } -- �� BUILDING PERMIT ISSUED-'1' ----------------- - = --------- � DATE/ -------------- Alterations and/or recommendations:____ ----------------------- :•_ ' '. --------------- .... '^.....6�___- ' ---?--.__.- L ------ •---------- - - ----- `--------['-- i ---- ------------------•---••-•------•-•-------------A--=-------------------------------------------------------- •------ -------------------------------------------------------------------------- ih t FINAL lN5PECTIONBY: L = = Date-r- :- ------- - ------------------------------------------i ----- I!c SAN JOAQUIN LOCAL HEALTH DISTRICT l� 130"South American Street 11 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100