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APPLICATION FOR SANITATION PERMIT Permit No. -- - -_ -L_ C ( omplete in Duplicate) i / P } Date Issued __ --S_/S 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,..4 JOB ADDRESS AND LOC TION---1___9�__A_.-3 �- ------- ------------- - Owner's Name � �� -------------------------------------- � Address---------------------- +fir __. Contractor's Name . -'• ----- ._----------------------- --- Phone-r--`1-6&V--;;--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __..-/ Number of bedrooms _7_-- Number of baths --/---_ Lot size Wafer Supply: Public-"system [g Community system ❑ Private ❑ Depth to Wafer Table #_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay EJ Adobe UO Hardpan ❑ 1 Previous Application Made: Yes l] No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION ANIS SPECIFICATIONS: (No septic tank t.or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------- -____--__--___-------__-:-_ ._ No. of compartments----------------- .......-Size....---------------- ---------Liquid depth----------- Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-__-_--- -:--- ❑ Numberof lines-----------------------------------Length of each line------ ---.-.Width of trench. t '' Type o30 f filter material-------------------------Depth of filter material-----------------------Total length---.-------------------------------------- Seepage Pit: Distance to nearest well----lQd--------Distance from foundation--__'A/�-.--_-.Distance to nearest lot line-.�D_________ Number of pits------p_.1 -------Linin material_C47_4A�`�Size: Diameter__,__3___ 9 -----Depth----- � ------------------- Cesspool: PWN Distance from nearest well-.---------------Distance from foundation--------------------Lining material-------------------------------- ❑ Size: Diameter----- ----------------------- -------Depth----------------------------------------------------Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------ Remodeling and/or repairing (describe)--------------------------------------------------------------------------------- ------------------- ----------------------------------------- -•-----------------•----•------,---- -------------•----= -----------------•-------- ----------------------------------------•-----•-----•--------------•---------------------•-------•-----------------------•----------•------------------------------------------------------•-------- ------•------ -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Shawslan rules an ' egulations of the San Joaquin Local Health District. r � c (Signed) ---- -- --- - ---S_CrY ,+-----t .'---------- By: Contractor) By:--------•- z [------ -{ -------------(Title)--- ------ Pot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed o averse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --yDATE------------------------- - --------------------------------------------- REVIEWED BY ------ DATE---- - �" = BUILDING PERMIT ISSUED-------------•-- ----_- /-- -------- -------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------- •-•----•------------------------•-------------------------------- --.-.- 7 -----•-------------------------------------------------- --------•- ---- ---------•----------------•---------------------------------------•------------------------------------------ ------------------------------------- ------------ ----------------------------------------------•-------- E •--------- - --------------------------------------=- ---------------------------- 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 ES-9-2M d0-52 Revised W-2100