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APPLICATION FOR SANITATION PERMIT Permit No. �___ . (Complete in Duplicate) __�� y Date Issued __ '_.._ ___~_� .i Applica'ion is hereby made to the San Joaquin Local Health District for a p r it to con trust and install the work herein described. This application is made in compliance with County Ordinance No. 549.0 srAe . Welt 1 0,51 - _S -r- ---- �. �� --S------t.�2�rc-- JOB ADDRESS AND L CATI. N -r-�--�-�`'�� L__ •--------------- Owner's Name _�_� � u��- �0/a� L`[I/�["��L ` --- --.C-h ------r---- ----- Phone------------- --------- AdcEress_. ------------- 1---------------------------------------_---`-�- ----------------------------- Contractor's Name-----MtL4-*_R�r-�{- 1 Y4- _CA---------------------------------------- Phone7L?...X.7,-0 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other.[�-- Number of living units: _"""" umber of bedrooms'1_ Number of baths _�____ Lot size ..... _ .,.__.P-----�5----_--------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of sail to a depth of 3 feet: Sd Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan pp ❑ Previous Application Made: Yes E] an No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) Septic Tank: Distance from nearest wr/�e�ll_________________Distance from foundation__-t_ ____._ paat rial__.----.____.-.-_--_ Nn, of com artments___„Crr------------------Size ___ ------ - -------Liquid dept 4------------------Capacity-- ---_ -- ` Pr1� ie"yCc�21r oar .. ✓ Disposal Field: Distance from nearest well-4a�.._Distance from foundation__"J-_ _ Distance to nearest lot line_----- �r ss X/ Number of lines_________ _____ ___________Length of each line__a _ --__- ___��_.Width of trench_____-- !K---- ' --------- - Type of filter material- ____ .____p�� Depth of filter material____. ..______Total length___ _______________________ t®,, Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------------------ F-1 ----- ""_""____-❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------__ Cesspool: Distance from nearest well-----------------Distance from foundation...._-_-_-__.____".Lining material""""_.__"-_"--___-________________- Size: Diameter-------------------------- -----------De th-------------------------------- ---Liquid Capacity -----gals Privy: Distance from nearest well------ --------------------------- --------------Distance from nearest building----------------------------- ❑ Distance to nearest lot-line- ------------- ------------ ----- ----- -•------------------------------------- --- �4��j -------------------------------------------- Remodeling and/or repairing (describe}:---*_ --- .^--------�-�� -------------------•----------------------------------------------- --- �h ------------------------ ------ `L ZZ _ _ -- = � --- _ -------------=-------�--=-----� " �rP-S- ----------------�---------------------- -- ------ 60 1 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 Sanpquinal H alth District. (Signed)----•------------------------------------------------------------------ ---- -- Contractors BY=-------------------------------------------------------------------------- -- - --------- ----- --- (Title]- ----------•-------------- (Plot plan, showing size of lot, location of system in relationings, e+ , can be p aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- DATE------------------------------------------------------------ REVIEWEDBY-------------------------------------- -------- ---------------------------- --------------------------------------------- DATE------ ---------------•------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- -------- ------------------•--------------------------------------- DATE----- ------------------------------------------------------ Alterationsand/or recommendations:------------------------------------- --------------•------------------------ _-------•-----------••--------------------------------------------------------•- ---------------------------------I---------------------:---------- ------------------------------------------------------ ---------------------•-------------------------------•--------------------------------------• ---------------------------- -------------------------------------------- ---------------------------------------•------ ---------------------------------- ------------------------------------------------------------------ FINAL INSPECTION BY:. --------------------------------•-------------- Date_ 7 ---------------------------------••- 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 B-9-2M ; - Revised W-2100