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43 APPLICATION FOR SANITATION PERMIT Permit No. -----�- (Complete in Duplicate) Date issued _-.-//;;,2��-. 1 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION..--1149_ desi.-----4.204t , �-------- Owner's Name-----------------------------------"0':xf tf!1 ........ a AJ--------- ----------------------------------------.-- Phoi ___-,--------- Address1=0 1s_ ---?4---------------------------------------------------------------.......••---------------------------------------------------------------- Contractor's Name-----•...................�_- ,��= ------- �"'---------------- ------------------- Phone -"- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms ..Number of baths --/-.. Lot size __- __'�-- --- -- -- -- --------------- - --- . Water Supply: Public system-bf Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No X 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 welL1A9 -__Distance from foundation-f 10-,0------..Material-.---- =f ,r� --------------- No. of compartments--- -------1, Size _. - ___-_-_Liquid depth_.a 6 --------Capacity------.Zae Disposal Field: Distance from nearest Distance from foundation----k_- ___-.-_.---Distance to nearest lot line-------- -------� Number of lines_-_-- -----------Length of each line------Z.Q.......- Width of trench. .. '!-------------.._.- yp rDepthter material-/._&'� ------Total length------Z-40.7------------------------ See a e Pit: Distance f to n arae t Iwlell flo� ------D stancof frl,m foundation_-�� ---.Distance to nearest lot line__...___-- p g Number of pits----------`----_-_--Lining mate-ial----Y- ►?! ---Size: Diameter__ -----Depth- - -------------------- Cesspool: Distance from nearest well--------------_-Distance from foundation___-----------------Lining material--------------------__.-__-_._--_. ❑ Size: Diameter-------- =------=7-------------=--De..pth-------------------------------------------------------------------------Liquid Capacity----------------------------gals. --'-------------------------------------------Distance from nearest building------------------------------------_-._-. Privy: Distance from nearest well--- Distance to nearest lot kne--------------------------------- `"'"' Remodeling and/or repairing (describe)---------------- r -----------------------------------------------------------------••------------------------------- --•------------------------------------------------------------------------------- ------•---------------------------- -- --------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and-thaf the work will be done in accordance with San Joaquin County ordinances, State WWI, and rules..and regulations:of the San Joaquin Local Health District. �C/ --.--t_-(Or"iFr-ant1V*r Contractor) (Signed)---- �,T�-------------- --�---•----- - --------�----�- -•---------- -------------------------- -- --- -. B ----------------�: ---------------- Y•---•..__-------------------------_--..------------------------ (Plot plan, showing size of lot, location of system i elation to wells, bildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY - --------------------------------------------------------------------•----------------------- DATE�"---------------------------------------------------- REVIEWED BY - DATE ------------------------------------------------- BUILDINGPERMIT ISSUED-------- -------------------------------------------------------------------- --------- DATE------ Z,,k- ----------- Alterationsand/or recommendations:-- ------------------------------- ------------------------•----------------•--•---------------•-• ---------......-------------•------------------------------- ------ ------------------------------------------------------•- --- --------------------------------- ------------------------------------------------------------- --- ----------------------------- ---------------------------- ----------------I---------------- ---------------------------------------------------------------------------------------------•--•- ----------------------------------------------------------- -- ----------------------------------------------------------------- ------------------ -- FINAL INSPECTION BY:--------------------------------- --=-- --------------- 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 1 ES-9-2M 10-52 Revised W-2100